The Warren and Harris ships have already sailed in favor of eliminating private insurance except as a gap supplement.
2
There are now over a dozen healthcare coverage proposals ranging from single-payer to some sort of public option hybrids. Some proposals like "Medicare For America" provide for a softer transition and allow people to continue to purchase private healthcare insurance, at least in the near term. Biden's plan is brand new and there's not a lot of details to analyze. For people timid about wholesale change to the healthcare coverage system perhaps Biden's plan is more comforting?
The Kaiser Family Foundation does a wonderful job of providing comparative analyses. It's a difficult situation for Democratic candidates because discussing these plans requires nuance and the media simply doesn't provide the means to do that. For anybody interested in reviewing the various proposals here is the link:
https://www.kff.org/interactive/compare-medicare-for-all-public-plan-proposals/
10
I’m always reading in the NYT that the NHS is the sole provider of medical care in the Uk and here we see it again. There is a large and thriving private healthcare system in the UK funded by private insurance paid by companies and individuals who can afford it. These people are, of course, also paying into the NHS via their general income tax. Hope that helps to explain the situation.
13
No one seems to have examined the effect that the employers who pay varying percentages of their employees' health insurance costs would benefit from no longer having that burden. Would they increase wages, thus making Single Payer premiums and/or co-pays. more affordable? It would seem that this would be a significant factor.
10
Can we please have Krugman answer some of the excellent questions posed by commenters here?
The cost in terms of new taxes has to be compared to the monetary benefit of no premium, no deductible, free coverage of the population.
If Krugman cannot do that simple calculation, I am sure an able grad student will oblige him CIty College Graduate School. A good estimate of both is trivial.
Doing some some sensitivity analysis about how progressive the taxation should be is equally easy to do.
We are not talking of Nobel Prize winning research but a longish homework problem that I remember him assigning undergrads at MIT.
Come on people, this is obvious: let’s keep asking for answers until we find out the truth.
10
@Blunt
If you want an accurate estimate, there is nothing trivial or simple about such a calculation.
Each of the 50 states has their own tax rules, insurance market, and covered population. Each of the 50 states has their own drug pricing, and health demand. A huge chunk of that is not even publicly available information.
If you think it's simple, why not do it yourself?
4
@Viv
My Viv,
What is an example of an “accurate estimate” in your opinion?
Why does it have to be an accurate estimate and not just a good estimate? Do you know the difference?
This is not precision engineering.
Yes I could do the estimate. A Harvard Doctorate in Applied Math is still worth something but the point is not my estimate since I am neither a journalist with a large readership or work for any of the campaigns of the candidates.
To make things work you have to want to make them work.
The estimates made in initial calculations of the famous Apollo projects were not as accurate as they became after mathematical filters of the Kalman type were used. Still we got there in the end.
5
@Viv
My Dear Viv,
What is an example of an “accurate estimate” in your opinion?
Why does it have to be an accurate estimate and not just a good estimate? Do you know the difference?
This is not precision engineering.
Yes I could do the estimate. A Harvard Doctorate in Applied Math is still worth something but the point is not my estimate since I am neither a journalist with a large readership or work for any of the campaigns of the candidates.
To make things work you have to want to make them work.
The estimates made in initial calculations of the famous Apollo projects were not as accurate as they became after mathematical filters of the Kalman type were used. Still we got there in the end.
3
Mr. Krugman- why would the tax increases for Medicare for All be daunting when a family's overall cost would fall? Some of Sanders' rhetoric might be off-putting to some, but who really is in love with their private health insurance company? One thing is certain, these powerful companies will not put up with the kind of regulation that they face in countries like Switzerland, a country that achieved full coverage in a private system. Further, we know that Pelosi got word to the insurance companies that Medicare for All would not be pursued by the the Dems. Why trust corporate Democrats, when they didn't even have the guts to put a public option in ACA? Biden, as usual, is unconvincing and late.
15
As a 70YO liberal Democrat, I wish that the republican's intentionally-false claims about Obamacare "death panels" were 'real' just for the purposes of whatever be the healthcare coverage 'owned' by Joe and Bernie -- the older-even-than-I guy's whose surnames are Biden and Sanders.
1
@Skillethead (who hails from New Zealand with an excellent example)
Makes perfect sense.
The pundit here will argue that NZ is too small what works there might not here and all sorts of such verbiage.
As I said in my comment, I don’t understand why the Times is not advocating for your type or many such non-profit solutions. The politicians like Biden, Pelosi, Schumer and that terrible man called Lieberman are all in the pockets of their corporate donors. The last of my list was fed for years by Hartford Insurers and after he left the Senate (sabotaging ACA so it didn’t have a public option that the Party is now willing to throw in to people as a bone) as a lobbyist for them.
But the New York Times? Why do they take the wrong side in history? Selling papers won’t be affected either way, by the way!
9
Frankly, a fair plan would nationalize all businesses. Their is no room for greed and racism.
2
Let them argue. It's not hurting the party, only them.
1
As usual, I agree with Mr. Krugman, that these two sniping at each other is not good for our cause.
But this is the first I've heard of Biden's plan for insurance coverage, and how it might work. Why is that not on the front page rather than being brought up on the editorial pages? I like what he is saying and hope that others like Harris will decide to make that more of their focus.
4
Paul has overlooked one simple argument that faces every American with the difference between Biden's plan and Sanders:
With Biden's plan every American is still only one major illness away from bankruptcy. Biden's plan does not eliminate medical bankruptcies. Sanders' plan eliminates that risk like almost all developed and a good number of developing nations.
11
The good news is the ACA 2.0 or Medicare for All would cover nearly everyone. The bad news is only Medicare for All is likely to give the government the bargaining power to push down costs about 40% to European levels.
While doctors will lose revenue per patient, they will pick up another 30 million patients.
10
Generally, impugning the motives of someone who is supposed to be on the same political side as you are ends badly. That doesn't mean it's wrong to point out that a colleague is objectively taking the side of the rich and powerful (i.e, the GOP side) on this or that issue. You're absolutely right that honest, serious policy discussion has to go on within the Democratic Party, and this is a big problem when people hurl accusations as the way to win public opinion.
Nationalize the medical insurance companies. As in 2008 we should have nationalized the banks.
9
What people love is their doctor/their healthcare providers, not their insurance company... but this can be so easily manipulated by pundits like Krugman to scare people into thinking they will lose their healthcare.
Krugman, your NYT/Establishment talking points are tiresome. You may or may not be smart enough to know that Medicare for all, as one bargaining unit, will get considerably better prices for pharmaceuticals and medical devices, also "paperwork" would be considerably simplified, no need for profit and overpaid CEOs with four hundred million dollar golden parachutes, no hundreds of thousands of dollars spent on campaign contributions, no billions of dollars spent on lobbyists... medicare for all will definitely cost less than the current health care system which takes 17.8 percent of US GDP, and gets worse outcomes than the next highest spending country, Switzerland, using 12 percent of its GDP for healthcare.
Krugman and the NYT are not interested in facts, they simply are committed to protecting the status quo...
their status quo.
Thankfully, Senator Bernie Sanders has the facts, the ideas, the integrity and the courage to be forceful with the facts and stand for the people and medicare for all.
A fight for a better, more fair future seems to be necessary.
12
There is a middle ground here. We have it in New Zealand. The basics:
1. You pick your GP. Don't like him/her? Change. Open market.
2. You pay roughly $30 USD to go see the GP. Unless you are a kid, poor, or old. Then it is various versions, but mostly free.
3. If you need tests, procedures, operations, you are sent to the appropriate specialist. All free.
4. GPs, etc., are paid by the government. They don't have to have insurance.
5. If you want, you can "top up" your coverage with private insurance. This allows you to go to a private (nicer) hospital, jump the queue for operations, get operations consdiered to be optional, etc. They come with various levels and various conditions and fees. (My wife and I buy the lowest level which means if we want something like an operation for arthitic condition, we can get it done right away and not in four months. But we pay a couple grand to do so. Works very well for us.)
6. There is no suing for malpractice, except in highly unusual cases, and the awards are small.
It's a system that works pretty well. We tend to be hyper-thrifty down nere, so we don't fund it as well as we should, but the overall system is solid. Single payer, can add additional coverage. Most people don't get the additional coverage, so it's competitive.
5
@Skillethead
Makes perfect sense.
The pundit here will argue that NZ is too small what works there might not here and all sorts of such verbiage.
As I said in my comment, I don’t understand why the Times is not advocating for your type or many such non-profit solutions. The politicians like Biden, Pelosi, Schumer and that terrible man called Lieberman are all in the pockets of their corporate donors. The last of my list was fed for years by Hartford Insurers and after he left the Senate (sabotaging ACA so it didn’t have a public option that the Party is now willing to throw in to people as a bone) as a lobbyist for them.
But the New York Times? Why do they take the wrong side in history? Selling papers won’t be affected either way, by the way!
3
Framing the conversation between Bernie and Biden as a street fight between two teenagers is a convenient way to get readers alienated from the underlying major issue.
Healthcare insurance like an army, navy, NASA and the NIH should be nonprofit and funded solely by progressive income taxes. There is no reason for health insurance to be for profit. Name me one!
The US Army and Navy, NASA and the NIH are excellent examples of well run institutions. They won wars, put men on the moon and come up with unbelievable advances in medicine. They are non profit! They have great administrators and managers who are paid civil servant salaries; not multimillion Corporate CEO salaries and bonuses.
Bernie or Liz Warren will find the money to make universal healthcare work. The savings from premiums and deductibles not paid will cover most of the tax increases (progressive and actually heavily progressive if needed to close the gap). Taxing derivative transactions and algorithmic trading (the latter totally useless from an social welfare and “completing markets” point of view) will provide additional funds if needed.
If you want to compare things, compare what we have with what I am proposing (a la Bernie or Liz); not Sanders v. Biden as if it is a boxing bout!
13
This argument is about whether the Democrats should run advocating an ideal system or moving in that direction to the extent possible. I would be thrilled to get to Medicare for All. But I recognize that the reality is that it just may not be do-able politically. As a result, I would be happy just to move the needle (no pun intended) in that direction, as far as possible. Hence, in my opinion, these are not mutually exclusive positions. I do not have a problem with a candidate saying 'this is what I'd like to do but here is what I will likely be able to do.' I wish more politicians would be frank in this way.
One reason it may require a step-by-step approach is that the GOP is going to turn its infamous attack machine on ANY Democratic health care proposal, and we know from sad experience that some people will be fooled by this nonsense. And at the end of the day, if the American people do not take the Senate away from Mitch McConnell this whole discussion is pointless.
4
I'm glad Paul Krugman is making these points about Bernie Sander's proposal and I very much hope Bernie reads his column. It is absolutely an election killer to announce tax hikes for the middle class when we all know by now that Amazon pays ZERO taxes, and the Uber-wealthy themselves announced recently in a public letter that they want to be taxed MORE. Please tax them and all corporation. (Also cruise ships that destroyed Florida's reefs and pollute for free.)
This self-defeating tax proposal by Sanders together with his battling cry for Revolution, and his dismissal of successful societies who have both national insurance AND private insurance, PLUS (I'm not done) the mantle of socialist he embraces (another election killer) that is inaccurate, to say the least, makes him appear tone-deaf. Bernie Sanders is not a socialist but accepts the label which makes me doubt he's in it to win it.
I don't like Biden for many reasons, but Elizabeth Warren has gotten my full attention, and I'm alarmed that she adopts Bernie's Medicare for All position. I wish she would reconsider, as she would if she analyzed the dynamics at play in this country.
People need choices. They need to be able to keep their insurance if they're happy with it. And the middle class goes not need to have their taxes raised for any reason whatsoever.
1
With regard to tax increases to fund single-payer, it should be noted that different governments in the US, already spend 7-8% of GDP on health-care. Those countries that have full single-payer, like Canada, typically spend about 10% of GDP, so with some re-jigging, it should be possible to achieve full single-payer coverage, with tax increases amounting to only about 2-3% of GDP. That would theoretically result in a saving of about 7-8% of GDP from the present situation, which would be a huge amount of money saved each year, and something well worth trying to achieve.
I realize this is very high-level thinking, and it would take major change in the US to achieve this. The point is, that it is feasible. Other countries, including my own, have done it.
2
@Pawan Jain
Canada doesn't have full coverage. It doesn't even have standardized coverage from one province to another.
The "low" cost of Canadian healthcare comes at the sacrifice that people with debilitating chronic conditions are still bankrupt. In Ontario specifically, more and more people are directed away from public care to private LHINs, which provide substandard care and in many cases don't even employ qualified health workers.
Those candidates who are unable to put party unity ahead of egotism are unfit to be running.
2
what I never see discussed is the fact that until the 80's all health insurance in this country, and also all hospitals, were non-profit by law. This is how the Netherlands makes its private health insurance work - insurance cos are required to provide health insurance if they provide other private insurance but they are required to provide it at no profit.
1
While Sanders' statement that "only single-payer can purge corporate greed from the system" may be "broadly hinting that Biden is in the pocket of corporate interests", Biden's declaration that "the Sanders plan would undermine Medicare", is a GOP based tactic of fear-mongering and flat out a lie.
Our candidates need to stop lying as they lose their credibility.
2
Improving the ACA and Medicare-for-all are not incompatible. If the goal is Medicare-for-all, the easiest way to get there is to add Medicare to the ACA exchanges. Medicare should be cheaper due to higher efficiency, and supports a wide network. That should make it attractive, leading to higher enrollment and possibly greater cost reduction. Then private insurers will be unable to compete, and they'll wither away.
The ACA's fatal flaw is that it maintains a capitalist system that puts wealth care for executives and shareholders far ahead of health care for patients. It only attempts to fix a few of the most egregious failings. But it's a start: Add more regulation so all the plans for each "metal" cost the same and access the same network (Medicare?). Add a standard prescription formulary and price list negotiated by the government, increase the subsidies, and you've got a highly-regulated private insurance market like Switzerland and the Netherlands. Those insurers might not make the mind-boggling profits American insurers enjoy, but they clearly make enough to continue doing business in those systems.
The real issue is affordable health care for everyone. I think all the Democrats can agree on that. Republicans (and the wealthy donors they represent) clearly have no interest in it. Fixing the ACA is a relatively straightforward interim solution that allows a proper debate to work out a long-term approach to the goal.
3
Rather than seeing infighting, I see healthy discussion that will help shake out the 2020 platform of the Democratic Party. Most of the candidates for the nomination have agreed to support the winner in the election. I have not seen much denigration by candidates of one another. I wouldn't call Ms. Harris's comments about Mr. Biden denigration, but a challenge. Strong candidates should respectfully challenge each other. It's one way we learn who they are and how they will tackle presidential issues when elected.
3
Does anyone understand the animosity shown by the Times (and by extension of its writers like Krugman) with regards to Universal Healthcare I this country?
We are talking about a human right that is taken for granted in the civilized world. A liberal paper and a Nobel Prize winning Keynesian Economist should not have any problems with its principle. Au contraire, they should cheerlead it.
There is the monetary cost issue but that can easily be estimated and compared to the monetary benefits (again easily estimated). The costs are additional taxes (progressively applied) and the benefits are the premia and deductibles we would save. Any Goldman Sachs first year analyst can do both estimations in a couple of days if they are worth their pay!
So why is the brilliant trade theorist and pundit going down to the level of comparing apples and rhubarb by comparing Bernie with Biden?
I am genuinely puzzled. The paper refuses to print most of my well argued, well written comments while publishing thousands of congratulatory, saccharine and almost monosyllabic stuff.
I am trying again.
6
Has anyone ever noticed how nonsensical the public debates are on anything of substance? Prominent arguments are often based upon a personal perception of direct, short-term, marginal effects of any policy change upon the individual.
I think this is proof that both parties have fostered a 'me first' attitude in our country. We should call this the 'me first' country.
I have to go and do my iTaxes. For me! Not for you!
I never hear of the other "taxes" we all pay for health care and the amount of money that would be saved if we eliminated no fault auto insurance for medical and the medical expenses from workers compensation both of which would be eliminated by single payer systems.
3
OK, DR. K, Biden and Sanders may be off-course (and off-message), but isn't the *real* "bad-faith" actor in the room the Republicans? As has been the case for the last 20+ years.
Republicans say "we should go back to a situation in which those whose jobs don’t come with health benefits, or who suffer from per-existing medical conditions, can’t get insurance"
And then "consistently lie" about their position".
While it's accurate and proper to point out flaws in the words of idea of Biden and Sanders (and anyone else), shouldn't the REAL focus of criticism and rebuke remain on the real culprits: the Republicans?
2
A fundamental flaw in all proposals regarding health insurance is that we are trying to regulate health care by regulating health insurance, which is the tail wagging the dog. We need to address both directly, and any proposal for one needs to align with the other.
4
@Al, yes! Everyone is always talking about health insurance while not talking about actual medical costs and how to bring those costs down. No one has had the guts to really start this conversation.
2
Its even more complicated than Mr Krugman is saying. Switzerland and Japan have private insurers, but the government sets the price they charge. Virtually all developed countires with single payer systems allow people "of means" to purchase private health insurance to see "private providers". The most efficient, cost efficient, and universal systems are likely some version of these single payer (with a buyout option) plans. Medicare advantage plans (private plans for the Medicare-eligible, are either far more restrictive (disguised HMOs), or cost more than 98% of Americans in that age group can afford. The wealthy can and do afford to pay their Medicare taxes, (currently a rounding error in their incomes, although it would become, God forbid, a larger rounding error), and buy private plans (concierge plans being an existing version in the U.S.). Krugman is right, people should have choices. The issue is: is health care a human right in our society, that all society members help pay for, even those who can afford to buy more expensive health insurance? For the vast majority of Americans, getting profit out of health care is the single best, quickest, and easiest way to get affordable, universal health care for all of us. Profit is poisonous to your health.
4
I think this is legally an issue for Senate candidates, not the Presidential candidates. The President just signs laws which have been passed.
On the other hand, Bernie is right that the presidential campaigns are part of a "political revolution", which will be required before the Senate can actually change parties.
So the political issue is whether "proposing" Medicare for All or stronger Obamacare is more helpful to pro-healthcare Senate candidates.
My opinion is that the tide will turn when enough people in Red states think that we are all in a healthcare system. What's important is not which "proposal" is in the mind of the President, just how much the debate engages voters. Voters who are engaged in thinking about our healthcare system will push for improvements.
2
Once again this points to why Bernie should stop being allowed to run as a democratic candidate for president. The man is not in the party and if he wants to run should run as an independent. Of course doing so would ruin any chance of ridding ourselves of trump and the GOP, but for the life of me I cannot figure out why Bernie believes he's entitled to the democratic nomination and I know someone who has worked for him for years. Even he can't give me a good answer to that question.
2
Since without Democrats taking control of the senate (unlikely anytime soon) neither proposal will be enacted, even if Biden or Bernie become the next president.
Why not lower Medicare age to 55, have a public option where insufficient competition exists, and keep Obamacare for everyone else? Has anyone studied this to see if it works?
2
"You'll be able to keep the insurance you already have," Obama said when promoting ACA. He figured that people were reluctant to lose what they had, what was familiar. Sanders says he'll take away what people have, figuring they will be really happy to get rid of it. Reluctant to give it up or happy? It's too early in the election season to claim that's been answered. Feel good strategies will not suffice as voters ponder questions more seriously and, if they are wise, request to be shown the fine print.
1
@blgreenie:
What Obama promised wan't *quite* true for everybody. A few people with generous employers, strong unions or liberal local laws lost the benefits of their "Cadillac" plans.
But the net result was a lot more more people covered, and most of them with wider coverage.
My monthly healthcare premium is about $1,500. My employer pays about 70% or $1,050 of that premium and I pay $450 per month. The 70% my employer pays is about average for what employers pay on a premium.
There is no way my employer any one else's would give their employees a $1,050 per month raise if the US Government started taking care of healthcare.
Does anyone really believe that my monthly premium at $450 would be the same under a government program? Guaranteed it would go up.
I speak for the 156 million Americans that have employee sponsored healthcare.
Please do not change out current system.
I have no problem for our government to set up a safety net for those whose who can't get employer based insurance but don't take away mine.
2
@David K
Let's say instead, your employer now has to pay a higher medicare tax for employees (but no insurance premiums), has to put $500/month into a Health Savings Account for all employees in lieu of a salary raise and now all outpatient transactions are pay-as-you go with no insurance claims processing? No claims processing means huge reductions in facility overhead, better price shopping if price transparency mandates passed, and true competition and innovations if coupled with more patient autonomy.
1
There are more than two ways to establish full comprehensive medical care, like a combination of single payer and private insurance. One doesn't rule out the other, they complement each other.
The argument that single payer is not workable is disproved by other countries that are providing medicare.
Given that both Bernie Sanders and Joe Biden are already handicapped by their age, it is extremely tiresome that they are using thier platforms to engage in nasty ad hominem attacks! Both should be forced to sit down and agree to disagree in a civil manner--like adults.
1
Single payer with private insurance supplements! And Big Government doing constant battle against Big Pharma and Big Med on behalf of the people and their bottom line.
1
Odd how it is only the democrats' programs that have to be funded. Republicans never worry about that.
3
If the Republicans succeed in taking away the ACA and all healthcare for indigent Americans, many people will die younger.
The average life span has already declined about 6 years for American men. Yet a majority of white American men continue to vote for Trump. What does this say about them?
Republican men are either so ignorant they don't know that their life spans are lessening due to Republican laws and policies; or, they know and they would rather discriminate against non-whites than they would like to live as long a possible with adequate healthcare.
I would love to see a poll on this topic.
1
In 2016 Sanders succeeded in getting Hilary Clinton to support the $15/hr minimum wage and to reject the TPP and Keystone pipeline; so why the heck would you want him to cut Biden some slack when it comes to providing Universal healthcare? This will put pressure on Biden to make the Public Option a very real and detailed part of his healthcare policy. Once the public option becomes popular, then the majority of the American citizenry will migrate to the government option/Medicare.
Personally, I'd prefer the government hand over all healthcare funding to Elon Musk and let him work it into something efficient and sustainable.
2
Yeah, and rejecting TPP was imbecelic.
I have reached the point where I don't care if we have universal coverage. While I know that my property taxes which border on $100,000 a year help cover emergency room care and uninsured hospitalizations, I don't think Americans are ready to pay for something that benefits people they don't like. And trying to change those people is ridiculous. Right now the word of the year is hate. It's Trump's word and its the GOP word. And we have to see just how ugly this attitude is before we will give it up.
A late comment here. Biden seems to have a lot of political baggage--incarceration, Thomas on the Court, and palsy-walsy with Dixicrats. Also a faked CV still with no plausible explanation--maybe, if he gets the nomination, we'll see another one saying he's always been a hedonistic racial bigot in order to compete with Trump. On the ACA, give Ted Kennedy credit for surviving to vote, just as McCain did to save it.
And the problem with Sanders is not single payer (which Lieberman single handedly shot down), but that he is a socialist "commie", maybe even a Black or a Jew. Single payer with premiums (that's how insurance works) would mean higher withholding for everyone, universal coverage including preventive care which is key, and lower healthcare costs across the board for individuals. The issue would then become, instead of who gets it, but how to improve it while still holding the cost down. A Public Option would just phase this in, as low-moderate income people would see this as a way to save on their healthcare, with better coverage. Socialism in this context, where all providers work for the government, is not even being considered. And insurers would still do well on the 20% not covered by a Medicare plan.
Let's say withholding went from 15 to 20%; this would be a 8% healthcare cost vs the 17-18% we are now paying. Plus it could apply to all income, raising FICA for high income individuals, those earning more than $118,000/yr, which by itself is long overdue.
2
The dirty little secret is that private insurers have ALREADY invaded both Medicare and Medicaid. Otherwise, why the ads for Medicare Advantage plans? These plans hit the sweet spot: Gatekeeper care with guaranteed premium payments from Medicare! These behemoths also administer VA, splitting the country three ways.
The battle is over. We have surrendered the field. Original Medicare does not advertise and cannot rebut the dishonest ads by Big Insurance and Big Pharma. CMS loves it; their costs are capitated. Wake up, people!
2
While Bernie has some good ideas, he needs to be more realistic--and he needs to bow out of the race, now. If he cares about his country and his party, he will leave before his rants do irreparable damage to the eventual nominee (which will not be him)--like he did to Clinton 2 years ago.
1
In my mind the greatest omission in the Affordable Care Act was a public option. So much dissatisfaction could have been averted.
3
@Larry
Much more dissatisfaction would have ensued.
You can't just pretend that adding a public option is a matter of words. A public option means that it would need to be funded, in addition to the funding provided as subsidies to those with private insurance.
Those things can't coexist. It makes no sense to subsidize private insurance and ensure private profits, while also doing the same thing for public healthcare.
1
@Larry
Obama lacked the courage to stand up to health insurers and pharmaceutical companies, just like he jailed no bankers.
3
It's remarkable how the debate has shifted. The excitement for the ACA was it would bring costs down, not that it would create a new entitlement. Is there a voting bloc out there excited for the same old overpriced healthcare, but just expanded to more people? The issue for nearly all voters who care about healthcare is bringing costs down.
1
I was pretty thrilled with the fact that it stopped insurance companies from denying coverage to those with pre-existing conditions.
2
Not to mention that it called the premium older Americans could be charged at 3x the rate of younger people. And it prevented insurance companies from calling the benefits they would pay out in a year or over a lifetime. It's not just about pre-existing conditions.
1
The debate between those who want to save the private insurance companies profits and continue with the horror of coverage denials and limitations and co-pays and deductibles and those who believe that everyone is entitled to health care as a basic right is a legitimate one. But it should be conducted honestly and without using the old disingenuous right wing scare tactics. Krugman, who in other matters, particularly economics where he definitely is expert, has a serious flaw in his political views in that he was and is so enthralled by Obama Nd Hillary Clinton personally that is cannot bring himself to acknowledge their major failings. Giving Obama the benefit of the doubt on intent, he clearly capitulated to the right wing plan which is Obamacare without really fighting for actual health care for all.
3
Both candidates are planning approaches to funding a system that is far too expensive. I'd like to see medical costs addressed not merely shifted from the private to the public sector.
1
Well stated !
Joe Biden and Bernie Sanders would be legally to old to serve on most corporate boards in America which cut the age off at 65.
Joe Biden and Bernie Sanders have been in politics, like, forever, and we've long since heard more than enough from these two august politicians for a lifetime! I say that as a Bernie fan.
Time for these old Democrats to be put out to pasture and let some young folks with better educations, broaded outlooks, fewer ties to corporate interests (Joe), take over the leadership of the Democratic party.
Joe Biden has always been a terrible decision maker. I am convinced that the only reason he is again usurping headlines is Russian Intelligence. Good by, Joe! I don't even think you are a nice old man. You are just powerful enough to be pushed by people who want to ruin the Democrats chances in 2020!!!!!!! Why won't the NYT write about this?
2
Just who is this Krugman guy anyway? Much too logical and level-headed for the 21st century. (heaven help us)
Can we afford health care for all Americans?
Well, you decide,
America now pays more for health care than any other nation on the face of the earth. 19 cents of every dollar spent in America goes for health care; that is 19% of economic activity is health care. 19%.
That's half again more than any other nation. Got it; everybody else pays like 12%.
AND they cover all their people; AND get much better outcomes by all the standard measures.
AND we are the only people who know what medical bankruptcy is.
We pay more, get less, don't cover everybody and let thousands die every year from routinely treatable ailments.
Them's the facts; same as for the last quarter century.
Can America figure out how to save 6% of GDP (that's a really big number, for you Americans not good at math.)? The people who elected Donald J Trump in a for-real election, who daily demonstrate they cannot figure out how to operate a turn signal ?
Will they be able to do what every other nation on earth does?
Nah. I doubt it.
13
There is another part that Krugman ignores while promoting this planned theft from the middle class and that is the crushing cost of the illegal immigration to this country. We have 100000 low skill invaders entering our country who are already a heavy burden on our medical care in vast parts of our country. The Democrats have at least stopped lying and openly admit they will provide health care for illegals at the backs of the American workers. It is sad that the press that takes every instance to accuse republican of lying do not acknowledge that Democrats have been lying about this issue. 10 candidates do not suddenly agree after years of denial without some collusion.
3
on the other hand, seems like Reps want to make healthcare unaffordable for most Americans, just to deny healthcare to illegals. Why are they honest about their intent?
1
DNC ASR’s you listening??? Can we please not sabotage ourselves, shoot ourselves in the foot this time around? Get it together!
1
Both of their plans are pie in the sky dreams. If the Dems don't take both houses and the presidency all of their ideas are academic musings. Democrats need to pull back from their "Big" ideas and win the damned election first. Nothing else matters but throwing out our Racist in Chief and his cronies in the Congress. Telling 180 million people to give up their insurance isn't the way to win, just reelect Trump.
3
I want the best of both worlds.
I want to keep our healthcare system intact. For the most part our healthcare system works for many Americans and I don't want the government (the most inefficient and least innovative entity in the country) getting involved. If our politicians can't stem the rising costs of healthcare now, do we really think they can do it after a 100% takeover of health care? Our government is $20 trillion+ in debt. Do you really think that our taxes are not going to go through the roof with a government run program or our debt will get worse because of this? Of course we will end up paying more for healthcare for worse service and a bigger deficit.
I want and we NEED a social safety net for health care. The moment a person experiences job loss of doesn't have employer health sponsored insurance coverage, lets face it, your screwed.
We need to continue to push for reforms in the current healthcare system and offer everyone else a Medicare option. In my opinion this is the most sensible solution. If the government can prove that they can offer cheaper and better health care coverage than private insurers for those on medicare, then, we can have a different conversation.
And one last thing. If anyone thinks that an employer would pass on to their employees any savings from healthcare premiums, you're a fool.
Until then, please don't throw out the baby with the bathwater"
In my opinion offering everyone else a medicare option (requiring some payment )
2
Didn't the Government already prove through Medicare? Note, contrary to the private insurances that have much more diverse pool, with mostly young and healthy people, the Medicare pool consists of old and sick people.
@yulia
Getting rid of the individual mandate was wrong in my opinion. I always thought that one of the ways private insurers make money was by having younger people on their plans because they do not have a lot of cash outlay.
Getting rid of this and not keeping people in the plan messes up the business model.
Health care should be a purity test for the GOP. If ya don’t like Medicare for all or improved ACA then you must support getting rid of Medicare. Let’s see how that goes over at the polls.
2
Another example of how Mr. Krugman, and The Times, subvert the urgent need to have what every other major country in the world has, health-care for all. In the process, by creating doubt, they undermine the chances for the success of the candidate and the health-care system that is urgently needed by so many.
Doesn't the Times, and Mr. Krugman. see the serious (and dangerous) point we are in US history. and the evident truth of Health Care For All should be supported both for the benefits it will bring and as rallying cry to win support ????
4
This opinion piece is piggybacking off of Sydney Ember's article "Sanders and Biden Fight Over Healthcare, and It's Personal", published July 18, and linked in this piece by "ugly argument".
If you read Ember's article, there is a huge slant against Sanders. He comes out the one being ugly. This is crucial because Ember has a well-documented history of being actively anti-Sanders. Oftentimes the pieces Ember writes are biased both in that the arguments critiqued aren't thoughtfully explored and that Ember often relies on fallacious arguments against Sanders, verging on ad hominems and definitely straw men. The bias is deeply embedded through the language used as well.
I just think this is important to note. I'm not at all saying there aren't valid points, I am saying that one needs to read these articles and realize that they aren't unbiased news reports, they are opinion pieces.
7
Why would anyone work if everything is free?
1
@Albert
Yes, work can give meaning to life, and provide challenge and satisfaction.
For society and the economy to thrive, be strong and resilient, we need to start with medicare for all, paid parental leave, then free/affordable quality childcare,
free quality early childhood education, quality K-12 education for all, and tuition free continuing public education.
1
@Albert John Maynard Keynes said in 1935 that in 75 years automation would let Americans work a 15-hour week. And yet we work more hours now than American workers did in 1935.
1
Why do you think sick people are able to work?
2
I wish Sanders would stop with the "corporate greed" stuff--that's all he has to offer, besides calling people "corporatists".
In his final statement in the first debate, he kept talking about how we need a "revolution". Bernie, that's how you lost last time.
Also the wagging finger and the lecturing and the complete lack of charm you exhibit will not get you the nomination, it didn't last time. Your running again on the exact same ideas shows you have an ego as large as, if not larger than, Trump's.
3
@klm
You don't believe corporate greed is a problem?!
US citizens have mostly watched passively as their democracy and ideals have been sold to the highest bidder.
Sanders has worked unceasingly for his life time to make life better for the ordinary people, and to take back our democracy from corporate domination.
You don't like "revolution" well just lie back and enjoy domination, not democracy.
5
What about health care for illegal residents, I see a lot of Dem candidates supporting it.
2
" No Democrat should be stooping to that level."
Yes, Biden should. If he wants to be president, that is. It's an ugly little fact that our politics have become (and I almost reflexively used the word partisan) so nasty. It's a now a cage death match. More sport than politics. If Biden wants to lose the "sleepy Joe" or "friend of racist" label he needs to "get out there and fight!"
I know that vision and competence are the main things, but without some junkyard dog in you, no one's going to listen. Remember the last person Trump labeled sleepy? It was - Jeb! Unfortunately for him, all his fight was in his posters.
It makes me want to scream when the subject is the burdensome cost of single payer even by my buddy Krugman
Consider how many millions are already covered by federal
taxes---- Every one on Medicare (me) medicaide and all federal employees-- everyone in the federal prison system and every one in the military and I'll bet I left out a few thousand here and there
Also when the question can be asked---- Where can we find the money to pay one third of what we are paying now??!!
The only REAL issue is what to do with the thousands who are currently shuffleing paper and denying care (insurance companies)!
4
Sounds like one candidate or the other, if a Democrat wins, my taxes go up.
1
@AutumnLeaf
and if you get a better, more thriving society and economy?
2
2 thimbs up. Constructive and not hysterically anti-Sanders.
2
While this bickering is troubling, at least the Democrats are talking about policy. Four years ago in their debates they were talking about who had the biggest hands.
2
It only took me a 60 second Google search to discover that the Netherlands does retain mandatory health insurance, but it's publicly funded and indeed this pandering to insurance company profit prevents it from being as cost effective as its neighbors, proving Bernie Sander's claim to be correct.
Sorry, Paul, if you own stock in that industry, but I don't think the average tax payer owes you a living.
5
Perhaps you shoulda spent a leetle bit more time.
https://international.commonwealthfund.org/countries/netherlands/
The Netherlands’ system is set up a lot like our own employer benefits: there’s a generous government contribution that—together with premiums that everybody pays if they possibly can—that covers the basics at least.
But. It doesn’t cover dental, vision, and some of the pricier benefits. For those, people buy private insurance.
It’s an excellent universal system, arguably the best in the world.
It is not free, not single-payer.
And St. bernie doesn’t know what he’s talking about.
1
The discussion always seems to imply that all costs, taxes, will be born by individuals. Why not a tax on business earnings comparable to what employers are now paying in premiums? All businesses should be investing in the health of their employees. All comparisons with peer countries show that our costs should be significantly less and if costs are spread over all payers now everyone should save.
4
Sounds like a good idea to me!
1
Of the four healthcare systems adopted by Western nations, the best are those in Scandinavian countries, all of which are versions of the Beveridge System.
Beveridge is the most efficient, least costly of the four. It's government run, single payer, basically what people refer to when talking Medicare For All. It is also not mutually exclusive when it comes to private insurance. Most Beveridge system countries have a vibrant private insurance industry.
Yes, a switch to single-payer would lose everyone their private insurer, but only because the entire private industry of healthcare insurance would change. It would definitely disrupt people's lives, in that regard; however, it would also usher in the most cost-effective and efficient system possible.
That said, it's heartening to know that Biden's plan is a substantial upgrade to ACA, which as much as I support it as a step in the right direction, has to date been a horrible development in our lives (double the cost for half the coverage).
Krugman is my favorite columnist. He has the most uncanny ability to explain complex issues in the simplest terms, and I really appreciate his many articles warning us against going single payer rather than improving ACA, but this just might be the one issue with which I disagree.
We need serious tax reform to eliminate loop holes and raise taxes so that we can, like Scandinavia, afford free healthcare and education for all citizens, AND -- ISSUE ONE -- get money out of politics.
3
I went from my employers private group medical insurance to Medicare at the beginning of this year when I retired. I pay as much now for Medicare for myself as I paid for my whole family last year under my employer plan last year. I paid over $200 for my routine dental checkup this year under Medicare and my supplemental Medicare Advantage plan. It was the first time in my life I had to pay ANYTHING for a routine dental checkup. Routine preventive medical care should be paid in full under ANY health coverage plan. The candidates proposing "Medicare for All" and are old enough for Medicare don't actually have Medicare themselves, do they? If they did, I'll bet they wouldn't propose Medicare for All.
1
I wish Paul Krugman would explain why single payer means higher taxes. Govt-run single payer would control costs, and not, as insurance companies are incentivized to do, raise premiums to increase profits and pay for expensive advertising, marketing, lobbying, and “contributing” to congressional supporters. If Medicare doesn’t require tax increases, why would a govt-run be more costly than the current system?
Otherwise, I fullly agree Biden and Sanders should stop the squabbling, and especially that Warren would return to her position of offering a govt-run alternative while for the near future preserving the unfair, costly, and ridiculous current system. Going for single payer now would give the republicans exactly the argument they long for: Dems want to take away you healthcare.
3
Bernie's plan is the most cost efficient. No insurance companies equals no profit taking or Wall Street skimming. American's will spend less of their income on health care with a single payer. Not rocket science Dr. Krugman. If corporations owned water and not municipalities, would we pay more or less for water? I thought so. If municipalities owned open land and not private interests, would housing costs be so exorbitant? I thought so. If the internet was a public utility and not a private Mad Max, would Russian bots have lobotomized the American electorate? I thought so.
7
As much as I respect Krugman, I question his cost estimates. When you see what the medical profession charges and then see what Medicare pays there is a huge difference. I wonder on which of those cost estimates his cost figures are based.
A not for profit system would, it seems to me, have a huge cost benefit.
3
Medicare has morphed into an appendage of the medical/pharmaceutical/for-profit health care industry, all of which serve their corporate masters. It is not what Medicare was intended to be. When people say, "Medicare for all", I cringe. Medicare, passed 53 years ago, is a flawed system that favors private corporate profit. I recently spent twenty hours overnight in a local hospital. The bill was $5000. Medicare paid $4000. I am on the hook for the other $1000. $5000 for one night in a hospital? Even though I could pay that $1000, I refuse to do it. My bill has been turned over to a collection agency, another arm of the medical/industrial complex. I will ignore it's attempts to collect it, block their telephone calls and any other attempt to collect it. I am doing this as my own little rebellion against an unfair and cruel system for the delivery of health care.
2
thanks, hope you enjoyed your stay, we (taxpayers) will foot the bill. I'm curious what the cost would be without Medicare? you think you can negotiate a better deal with the hospital and insurance companies?
1
Biden's "plan" can be summarized by saying that he has absolutely no interest in addressing the outrageous and out of control costs of both insurance and health care, and has every interest in funneling taxpayer dollars to insurers, big pharma, and health care
Sander's plan can be summarized by saying that he intends to replace one bloated and wasteful bureaucracy with another, with no plan to address outrageous costs of health care, and in many instances actually raising the cost of premiums for many in the middle class with his 10-12% payroll tax.
2
The inconvenient truth is that the demand for health care is essentially infinite and resources are limited. Access is limited either by price or rationing. Most countries practice some combination. State expenditures define the limit of care. 'Price' plays a roll even in 'single payer' systems such as UK where specialists are allowed to serve private for-fee patients as part of their National Health practice. Most health care systems allow for private insurance to cover the shortfall of the public system and give a measure of choice in care.
The most important political issue in the US is the right to health care and to propose concrete steps to make it available to all residents as well as reform the system, e.g. regulate drug prices as per Europe. Let's not get lost in the weeds.
1
The problem with immediate implementation of “Medicare for All” is that Republicans will demonize it and terrorize voters about taxes rising and losing their current private insurance. Just look at the playbook utilized during the implementation of the ACA.
Ideally, The goal should be “Medicare for All” but achieved through gradual implementation - first offer a public option for people below 65. At the same time, institute limitations on private insurance - more required benefits, limitations on private profits, and Limits on the unbelievable deductibles - no insurance on The ACA or offered to private companies should be allowed a deductible over $1000 for starters. All insurance companies and hospitals should be moved toward non-profit status with a strict definition of what exactly constitutes a non-profit, including limitations on salaries of executives and the amount of money taken that is not directly related to customer care.
If done carefully, each incremental step will become as beloved as coverage for children until they are 26 and no exclusions for preexisting conditions.
The problem is that all any this requires a good faith buy in by insurance companies, politicians, and health care providers. What are the chances of ever getting that!
2
I'm wondering whether Paul Krugman actually listened to Bernie Sanders' Medicare speech, or if he just read The Hill's interpretation of it. The article he references does make it sound like Bernie is being mean to Joe, but I listed to the entire speech and that's not what I heard at all. How is it a personal attack on Joe Biden to explain why Bernie thinks his plan is better? One of the reasons it is better is because it takes corporate greed out ot the health care system. And Joe Biden is actually LYING about Bernie's plan, which Mr. Krugman admitted. I think we have a false equivalency here. The candidates have to try to differentiate themselves from each other, and I don't think there is anything wrong with that unless they are lying or spinning a truth completely out of proportion.
8
Thank you for pointing out the key point, which is that at least all the Democratic candidates are proposing viable solutions to improve healthcare as opposed to the complete lack of a plan by Republican. This is the main contrast, so we should always take this into context when discussing the different proposals by Democrats. The candidates and the media need to make it clear as the primary proceeds how these proposals compare to Republican alternatives.
5
It is true that there are two ways that a society can provide decent, affordable insurance that covers everybody. Krugman is correct that single-payer works wherever it is tried & is by far the most comprehensive & cost-effective way of providing it. Keeping private insurance can be made to work, but only if we turn the clock back to before Nixon's HMO law in the early seventies. The secret to making private insurance work is removing the profit motive. Until 1973, all "private" insurance was through non-profit companies, primarily the original Blue Cross/Blue Shield. If you are old enough to have had this coverage (I am), you will note that there was no deduction from your paychecks, no annual deduction that had to be met out of pocket before a dollar was distributed, no copays (except token ones on pharmaceuticals), no annual or lifetime limits, & no areas uncovered. There was a one-year wait for coverage on any illness you had been treated for within the past 3 months, but no actual denial for pre-existing conditions. In fact, a law was in place that required your previous insurance company to continue to reimburse you for up to one year after the end of the policy for any illness they were treating you for when you terminated the policy, so the one-year restriction by the new policy is effectively covered by your old one. Costs of administration were low because there was no fiduciary responsibility to pay investors before subscribers.
Mr. Biden wants to keep Aetna, Humana, UnitedHealth and the other big insurance corporations in the drivers' seat of our healthcare system and protect their billions in profits and multi-million-dollar executive salaries. Taxpayers will continue to subsidize private insurance for the millions who can't afford the premiums and deductibles. Biden just wants to give more "handouts" to the insurance industry to cover more people and they're happy to take them. More guaranteed customers, no risk, guaranteed profits. Isn't "capitalism" great! At what point do Americans say, "Why not cut out the middle man?" Sanders needs to go on the offensive and ask Biden that question. Why are we paying insurance companies to do what the government could do cheaper?
7
There really is no argument here Biden is wrong Bernie is right. Of course there are increased taxes. One thing you own know is almost all the hospitals in Canada are publicly owned smaller
remote communities even have hospitals say 7- 800 people. They do minor operations but for more complicated operations they are either flown or are taken by ambulances. They are paid for by the provincial government with some money from municipalities. I can`t imagine doing it any other way. Profit should not be the motive when it comes to health care. It is immoral to do otherwise. So that maybe Bernie`s biggest challenge. I think the people who put the red herring of liking their insurance company I would say compared to what? If you have medicare you worry about anything.
5
@Gary warburton
Unless you're suffering from a life-threatening urgent illness, no the province will not bear the cost of flying you at its own cost.
You have to pay for that yourself.
Ask women in PEI who wanted abortions and couldn't get them there for 35 years, or women in Ontario who wanted abortions and were asked to pay for them themselves.
Ask families with cancer patients (including children) who stay at the Ronald McDonald house charity and sell their assets just so their kid could be treated at Sick Kids in Toronto because no other pediatric hospital provides comparable treatment.
Good job with this article Mr. Krugman. Your points are valid. The DCC should save the health care debate for their battle with Trump and the Democrats should demonstrate a united front behind a single message: "We will Deliver the healthcare that our citizens need and we will do whatever it takes to reach a system which we can deploy." The 2nd message is this. In order to give you the health care you need, we will need to take back the Senate and not just the White House and hold the House of Representatives.
The Democratic party needs to become unified. Bernie and Biden need to back off the details of health care for now.
I say, "Medicare to be available for all" and that "providing a Medicare option to everyone will put pressure on private insurance to become more competitive, efficient and focused on preventative health, support for integrative medicine, stem cell therapy and education about the harm of pesticides. To do that, getting the influence of big pharma out of DC is mission critical. That should be the unified message. These Democratic Presidential candidate need to focus on pragmatism based on principle and there will need to be compromise.
The strongest arguments Bernie can make against Biden have to do with his record on "throw away the key" criminal laws that he championed that put millions of African American in a virtual Jim Crow environment, and his support of major banks. Biden can claim Bernie isn't practical, etc.
1
Let's face the truth. Both of these men are too old to be President. As an octogenarian internist I have observed the aging processes of many others in addition to my own. As you all know,the endless stream of mental exercises and supplements have not been able to stop the deterioration of the old brain. Biological change can be tweaked in some places but it cannot be stopped. Both of these fine men are very skillful at concealing their decline but do not be fooled.
5
The reality is it doesn't matter which or what plan is implemented. The entire political spectrum refuses to address the fundamental drivers of sky rocketing healthcare costs.
1. Poor lifestyle choices
2. Over medication and treatments
3. Pre-existing conditions
4. Artificial pricing
5. R&D spending on terminal illnesses
And let's not forget the whole European health care is better thing is full of holes the left likes to ignore. I've heard more than I care to remember that their systems are not universally the best in the world from the people using them. Just because something is free doesn't automatically make it better.
3
But it costs less, covers more people, is stable and delivers pretty good results in term of medical care. Just by these criteria European system better. It is difficult to argue about benefit of overpriced system.
1
Not all private insurance universal health systems are the same. The countries commonly cited, like Netherlands, Switzerland, and Germany, all have private insurance systems that are completely different from the US insurance system in one major way- price setting.
Medical prices are set regionally by insurers as a group negotiating with medical providers as a group, not like the american systems which is a free for all. Hence, in these countries there is one medical price for a region instead of 100s of prices in America. We're Democrats so we're capable of differentiating between how medical prices are set.
NO major country besides the US lets those prices get set between private insurers and medical providers negotiating in a chaotic free market because history has proved it just doesn't work in health care. Republicans tend to be too blind to recognize this point because they hate comparing apples to apples- health care systems to health care systems and just want to stick to ignorant notions that the free market will fix all in ALL cases.
Biden's plan does nothing about collectively setting prices for medical services and hence would have no real cost controls, like the ACA.
4
Also these countries don't have employer-based insurance
1
When Medicare was instituted in 1965 the health care system was non-profit. People got health care for what that care was worth. Medicare addressed the problem of poor, sick and elderly not being able to pay even that. Unfortunately, because the way the law was written, health care was allowed to become a private profit enterprise. What was intended as a program to bring more affordable health care to more people turned into a feeding frenzy for the new health care insurance industry because Medicare pays only 80% of costs. On top of that, Medicare began supporting the private profit of huge medical care providers and the pharmaceutical industry by not questioning any invoices that were submitted to Medicare. In other words, the medical insurance/hospital conglomerates/pharmaceutical complex is abusing the original intent of the 1965 Medicare law for private profit paid by taxpayers. This sick system of profit was rejected decades ago by every other advanced nation. Single payer health care, administered by government employees, not corporate CEOs and stock holders, is the obvious solution. Our political parties don't seem to get this because they are paid to keep this sick, unfair system.
6
Insurance companies as villains–no doubt. But they don't have a monopoly on greed. An alternative scenario: if the coverage were Medicare and its limit to the stay 4 days, would the patient have been sent home after 4 days? Did provider billing influence the medical decision of the longer stay?
Yes, other countries utilize private insurance companies. But all are non-profit! Let's start by taking Wall Street out of our health care decisions.
7
As long as the questions are lofty abstract principles, Mr. Krugman enjoys flogging the Republicans for their cold-hearted, capitalist greed. But when opponents, especially the Socialist Sanders, put forward any practical proposals that might alleviate the dire conditions facing the US working class? Suddenly, it becomes completely impractical. Taxes would have to be raised! "Independent" studies reveal difficulties! And so forth. . . . And this turnaround is exactly what the capitalist Democratic Party candidates (except for Sanders) will do, if one of them is elected President. Voters beware!
3
Krugman seems to make an all too typical mistake about Sanders’ advocacy for a single payer system. He seems to believe that it is merely some crusade against corporate greed. But Sanders’ and others’ advocacy for a rational, cost effective system is more nuanced than that. That corporate greed has led to a costly bureaucracy specifically created to deny patients’ claims. Hospitals and doctors’ offices have to employ people just to deal with that bureaucracy. It is estimated by most experts that 12 to 15 percent of our health care dollar is wasted on that bureaucracy. We will never achieve the cost savings necessary to fully cover everyone until we eliminate that waste. I suppose that if we had a less corrupt system and private insurers in this country showed any willingness to stop gaming the system and cooperate in the dramatic reform we need, it might be possible to include them in health care reform. But they have proved with Medicare Advantage and the ACA that they cannot be controlled and will add prohibitive administrative costs to any system they participate in. That is the significant difference between our private insurers and the more controlled entities in Europe. As for this great affection people are supposed to have for private insurance, when it is explained that we will receive more care, freedom of choice and stability in our health care by eliminating the private insurers, I think you will see that allegiance vanish.
3
The only way the Democrats stand any chance of defeating Trump is to get voters to the polling booth in November. The Republicans did just that in 2016 and I expect they will again.
1
It's really disheartening when Krugman raises the specter of higher taxes, because of course he means higher taxes on "regular" Americans (it's a great scare tactic) as if that is the only way to get to paid-for single payer healthcare. We currently have the most wildly expensive healthcare on the planet. If reforms were implemented (we have lots of successful models to choose from on how and what to do) we could get costs down to what other countries pay. I am confident taxing Wall Street could cover the resulting cost of single payer healthcare. As it is now I am very concerned how Wall Street, which is essentially gambling, is such a big part of our economy.
5
@JK
What reforms are you specifically referring to?
Biden and Sanders are two old white men and their ideas are old as well. If the world is going to move forward we need youth, minorities, and women in leadership positions.
1
Mr. Krugman is right to suggest an end to infighting. But we really need to do what Biden is not doing: ask pointed questions to redesign our "healthcare" system to stop bilking the sick.
What will stop insurers, hospitals, and providers from fixing high prices in undisclosed "trade-secret" protected contracts? Why should those players be allowed to hide that they will charge unwitting patients $250 for a $2 tube of antibiotic ointment or other necessary medical treatment? The government would impose antitrust penalties on any entity that cut such a deal in any other economic sphere.
Why shouldn't we fix premiums at $100 or $0 monthly, instead of the unconscionable $2,000 monthly charged for some limited HMO insurance with Kaiser, whose CEO makes $10 million annual salary to run a 'nonprofit'? Insurance premiums are de facto taxes. We have no qualms about taxes or deficits for the 60% of our federal budget devoted to "defense" spending, including over $2 trillion wasted in Iraq and Afghanistan. Should we balk at taxing to help rather than kill people?
Why allow insurers to impose $5,000+ annual deductibles, hiding loopholes to avoid coverage for serious conditions like sleep apnea? Why shouldn't our "healthcare" system provide full dental and vision coverage? Are healthy teeth and eyes unnecessary?
Yes, it would be great if politicians actually analyzed and solved our "healthcare" problems. Meanwhile, contrary to what Pete Townsend sang, we will get fooled again.
4
I don't understand. Medicare uses private insurers for supplemental and "Medicare advantage". So what's the beef about "Medicare for All"? Just start incrementally lowering the age of eligibility until we're all covered, and let us choose our own supplemental plans.
Basic healthcare should not be a worry for anyone.
6
@Chris
"Medicare for all" apparently does not mean "a medicare option for all, with optional supplements", but "just medicare for all"
3
But Bernie wants to get rid of Medigap and supplemental plans. “Medicare for all” is a misnomer.
As a US citizen who has been a resident in two European countries, Canada, the US and currently lives in Mexico. I have a different perspective on the problem with healthcare in the US.
It is ridiculously expensive, who pays for it is secondary.
All the various proposals are methods to assuage the symptoms of this problem and at best indirectly effect the root. I don´t pretend to be an expert on how to improve the situation in the US, but I do have some observations: the US has very high salaries for medical personnel compared to every country I´ve lived in, hospitals are more like gilded temples than deliverers of services with the corresponding overhead and costs, and it is impossible to meaningfully compare prices and services . This structure just needs to be blown up. I fear medicare and the like and private insurance simply cement in place a system with the wrong priorities.
I do hope the situation improves for my fellow citizens in the US but I doubt it will happen soon. So, I will have a heart valve replacement here in Mexico or Spain with excellent service for a fraction of the cost in the US even though I could return to the US for this with Medicare picking up most of the tab.
3
It seems clear that the ultimate goal ought to be a single-payer system. What good does the insurance industry bring to U.S. health care? A whole lot of unnecessary cost and enormous bureaucratic complexity. Get rid of it!
But many people are fairly happy with their current program, especially contrasted with a vaguely defined future system. I am personally reasonably happy with my current HMO. What I would like to know, Bernie, is *how* are you going to get me and us from here to there? We're all worried about what the transition will look like.
Maybe details are buried in write-ups on some candidates' websites, but we don't hear public discussion or debate about how the transition would actually work. Of course, it would be further complicated by Republican opposition. Yet even if that could be surmounted, how will *my* HMO plan be converted into Medicare-for-all? How will all the other, diverse plans be transitioned?
We need to get to a single-payer system and bring down the unnecessary costs. But how can we feel comfortable about how long it will take and how it will work for each of us during the years before it is fully in place?
3
I think the problem here is the Republican dumbing down the Affordable Care Act. It originally was intended to be a single-payer insurance (not compulsory) but the Republicans picked and chipped away at a well-intentioned solution to our problem of medical coverage for all. They are still doing it. I think Biden should reinforce the Affordable Care Act. Leave Medicare alone. Improve what we already have. We have possibilities already in place.....just need someone to pick up the beacon light and see us through it. And please, please, please, candidates, stop tearing down each other. It will be very easy for me to stay at home from the polls if you have convinced me that whatever candidate you've bickered with, is not worthy of my vote.
3
I’ve seen evidence first-hand that Krugman is partly wrong in his descriptions of the pros and cons of the Sanders and Biden proposals. Sanders’ is far, far superior.
In Germany where I lived for years, private insurance is a large part of the approach to universal healthcare, and it’s true the system is far better than ours, as experienced by the far, far superior experiences that both my girlfriend and I had in Germany when we had serious healthcare needs there. But the private, profit-seeking elements of the German system really also inject very serious suffering for my friend Barbara, her mother Traude, my friend Susanne, my doctor friend Dorothea, Dorothea’s patients and countless other Germans — and I really mean serious suffering. Far more than implied by Krugman’s description. The system is better than ours but still plagued by stupid, costly, people-hurting elements caused by partial reliance on “healthcare-for-profit.”
In Canada and the U.K. where I spent much time as a tourist and have several friends, including business-friendly conservatives, the fully government-run health systems (like Sanders’) are far superior not only to our system but also to Germany’s. The taxes that fund their systems are NOT problematic. Nobody loves taxes, but Canadian and British capitalism, corporations and small businesses are all thriving, while tax reduction is not a hugely important, top priority for the majority of these countries’ voters and leaders.
10
Thank you
#Bernie2020
3
Yes, Mr. Kruger, you ARE speculating about how a single payer system would work out in the US. It works reasonably well in other countries, but if you want a glimpse of how it would work in the US, take a look at VA Administration or at the Postal Service. I come from a country with a single payer system and I’m not afraid of it, but government work in the US is abysmal compared to Europe or Canada.
2
Medicare for all is frightening people in purple states, at least where I'm from and the comments I hear. It sounds as if some of the Dem candidates for president would rather be right than reasonable. The Dems need the purple states to win. Period. Let the country not go through another Nixon landslide against McGovern. I fear this might very well happen if the Dems don't stick to bread and butter issues and quit the grand standing. The other is to stop taking the president's bait. He's the creator of the issues and the Dems and the media let him lead and disrupt. The most interesting development among people I talk to is a surprising interest in and acceptance of climate change from people across the board. It's a jobs issue in so many ways, and the Dems should emphasize it and educate people on a concrete vision of what we must do. Not just fleeting talk of " investing in solar and wind". Jobs, health, and world standing.
1
What is frustratingly missing from this column and from most discussions about so-called “Medicare for All,” is the fact that a significant percentage of Medicare recipients also have supplemental private insurance. For many, many people, Medicare is not simply a single-payer system and they are happy with their combination of government and private coverage. What Sanders is proposing is to eliminate all private insurance (except for things like elective plastic surgery and dental care).
3
There are no government providers in Medicare. None. Medicare simply describes the agency that collects the premiums, pays the PRIVATE docs and hospitals, regulates and reserches.
2
Professor Krugman makes a widely believed but erronious claim early in this piece: "More than 100 million Americans are covered by Medicare or Medicaid, which are both single-payer programs." For the record Medicare is not "single-payer." There is a 20 percent co-payment for most Medicare services. This co-payment is the responsibility of the recipient and is paid directly by the recipient or through a supplemental insurance policy or some combination of the two. Medicaid coverage is an even more convoluted system with deductibles and copayments depending on one's income. Obamacare or the ACA is not a single-payer system either: it is basically regulation of the private health insurance system with more lenient income provisions than prior Medicaid coverage in some states. But most problematically for recipients coverage availability varies from state to state, making the the word "universal" as problematic as the phrase "single-payer" for Medicare and Medicaid.
9
Sigh.
“Single payer,” means that a single agency of some sort collects premiums and co-pays, and pays the providers.
I’d like to recommend reading Kaiser Family Foundation’s excellent intros to this stuff, and well as this paper’s “Upshot,” section.
No candidate talks about containing cost of healthcare. Without containing cost or determining exactly what drives the cost, there is no way to afford universal care. And let's not just blame the pharma industry or the hospitals or the doctors. We are also to be blamed for high healthcare cost since we were so easily duped into believing "death penal" ads. Otherwise, no amount of government subsidy is going to solve the affordability problem. Stop pharma ads on TV and radio. Truly weigh the cost of paying for $10,000 chemo drug to prolong one's life for 3 months when one is 85 years old. This is the kind of discussion we must have before we expand access and bankrupt the country.
4
Sanders is correct that only a single-payer system can tame the corporate greed of the pharmaceutical, insurance and other healthcare-related industries that is at the heart of our problems. Comparisons with Europe are only so helpful here because those countries have publicly-funded elections and industry lobbying is considerably less effective there. We have a uniquely corruptible political system and its the reason we pay twice as much for healthcare while tens of millions still lack coverage.
While a more complex mixed private-public system like those that exist in several European countries sounds plausibly workable, such proposals greatly underestimate the likelihood that private insurance companies would use their enormous political power to bend them to their interests.
The private insurance industry is purely parasitic. it maximizes its profits by denying people healthcare they need. Some private insurance plans are better than others but nobody really "likes" their health insurance providers, most of which are not chosen but imposed on them by their employers. People like their doctors and want to be assured that they will be able to continue seeing them, something that the existing system doesn't really guarantee. Since all doctors will be "in system" under Medicare for All, it remains the best way to ensure this.
Biden's proposals reflect his subservience to corporate interests. Its ridiculous to pretend otherwise.
9
What’s ridiculous is to pontificate without knowing the simplest things, like Presidential candidates get some funding from government or that Obamacare was specifically designed to take advantage of at least some of the best aspects of European systems. Or that the costs of a lot of systems are starting to go up as populations age.
And congrats: you actually managed to find stuff to attack that isn’t really an issue with private insurers...no mean feat.
Briefly put, you can yell it as much as you like: M4A is not the only way to fix this.
I read Kurgman's column today, and I agree with his premise. However, twice he referred to Sanders and Biden actions as detrimental to "their" party. As far as I know, Sanders still identifies himself as Independent. I don't think Sanders is concerned with any damage to the Democratic party.
4
Since every other advanced country manages to provide healthcare for everyone (at far lower prices than we pay in the USA), one has to wonder if Americans are more greedy than other countries' citizens. There's a resentment about the "undeserving" (immigrants, homeless, children in poverty, etc.) who might get medical care that "we" pay for with our taxes. They can't understand (or they also resent) that our taxes also pay for education, whether "deserved" or not, because an educated population--like a healthy population--is good for the nation as a whole.
It's the Republicans whose greed and resentment seem to be the major problem. And as long as they're controlling the government, it's unlikely that anybody but the wealthy will prosper.
6
Debate participants are using "Medicare for All" as a simple panacea. It is not. I'm on medicare. I like it, but It is full of nuances, complexities and control by insurance companies. Maybe he phrase "Medicare for all" is good for political purposes. There is another approach. One participant should get out of the weeds and advocated for the goals and needs for universal health care rather than the detailed methods of a plan. Focus on need (people can connect with that), not plan (hard to relate to).That participant should then show us why she or he is the best choice to lead us to fruition of such a plan and who could bet beat Trump. Without such a victory there will be no universal health care. In the primary I am looking for a winner and a leader and a moral head of state who can regain our place in the world. As I listen to the debate I am not looking for a policy wonk debate.
3
All we need is to be able to buy into Medicare through a pre tax payroll deduction and allow CMS to negotiate drug prices. The larger the pool the greater the negotiating power of the American public vs Big Pharma. The private industry will get better and cheaper or it will fold. Eventually this will naturally lead to a single payer system. Medicare is exceptional insurance.
3
Medicare isn’t insurance at all. It’s an administrative system through which one gets insurance.
The Democrats and the ol' "circular firing squad." We gotta hang together folks, or surely we'll hang separately.
1
The past has shown that healthcare is a hard sell as the special interests will fight any changes (health care industry including corporate style non-profits)
If someone want to win election then work on this later please.
We can stumble along. Trump is not doing anything real on health care and there is a good reason.
Who wants to win the election? These two older fellows can screw it all up and then just retire...
I like both of them but if they make this all about themselves i can say goodbye to them, too.
2
For the love of god, Paul, tell me what's wrong with this simple logic:
Under capitalism money makes money.
Really, only the govt makes (prints) money. i.e. Wealth is transferred, not made.
So, in order for capitalism to work (not run off the rails of inequality) an appropriately progressive tax must be in place.
The job of an economist should be to determine the appropriate level of the top tax bracket. Obviously, history tells us that it is above 70%.
So, TAX FIRST for the purpose of the value we place on equality. THEN think how to redistribute those collected taxes.
What do you think, Paul? Isn't it just that simple? Do you read this stuff?
4
Unfortunately, the moderators of the debates do not understand healthcare enough to ask the right questions, so there are never any meaningful answers. Perhaps NYT needs to sponsor a debate with YOU as the moderator (I'm serious!). Here is one of my questions: As an old person covered by Medicare, I also pay hefty premiums for a MediGap plan (the 20% of Part B coverage co-payment). The MediGap plan is private insurance. How will this be handled? Not to mention my Drug Plan premiums. If private insurance and all copays and drug payments go away, the cost of Medicare will skyrocket. Even if we get pharma under control. How is this going to be paid for ?? Another issue: I live in a great metropolitan area. We do not have enough healthcare providers. People can't get appointments with primary care providers in timely fashion - yes, even those with good insurance. Are there provisions to increase funding for training? I can't imagine that physician payments will go up under Medicare for all. Where are the providers going to come from?
3
I challenge sanders to convince union employees to give up their good quality private insurance and replace with Medicare. Won’t happen and he’s a fool if he thinks otherwise. I’d really like to see him get doctors agree to a universal pay cut if all patients were paid from the Medicare price list.
The sad truth is these democrats who are advocating for a single payer system are lying, they know it will never happen. Especially if we don’t replace Mitch McConnell and the Republican majority in the senate.
2
You don't get it. The American voting public hasn't a clue about their own finances, let alone those of the federal government. So, they believe anything that lines up with their biases or anecdotal experience. Otherwise they would have to admit that they are ignorant which people are loathe to do. So, they will keep voting for voodoo economic policies over and over again. Make no mistake the health care debate is purely an economic issue in the minds of most people.
2
sorry, did you say something? I wasn't paying attention... yet.
Give me a minute. I’m searching back through the paper to see if I can find a headline ‘Trump Behaving Badly.’ Short and sweet.
Haven’t found it yet. Will get back to you.
2
And as the world moved on, two old men did as crotchety old men have done for as long as anyone could remember: stood on their lawns divided by the property line and continued to shake their fists at each other...
2
I am ready to salute Biden and Sanders for their fight for National Health Insurance, absence of which is an act of high treason by the US Governments against the People. But I doubt that this campaign would succeed, when led by a limping Democrat and a socialist laying eggs, from which hatch the likes of Ocasio-Cotez, more socialist than "the Pope" Sanders.
2
There are several factors that would make the coexistence of public and private health insurance problematical.
First and foremost is the role of money in politics. To guarantee their continued profit levels, insurance companies will lobby legislators to undermine any public plan through higher premiums and benefit limitations.
Second, prices can only be controlled if there is a single payer in the market.
Third, full time employees of established corporations tend to be healthier, burdening any co-existing public option with subscribers who are more expensive to cover, while private insurers cherry-pick the healthy.
Finally, public insurance reimbursement rates are low. Providers now rely on a mixture of low Medicare rates, higher private insurance rates, and exorbitant private pay charges to meet their profit targets. If too many patients enter a public plan while privately insured patients are still numerous, providers may simply stop treating publicly insured patients, as many already do. This is why prices can only be controlled if there is a single principal payer.
4
And yet public and private insurance coexists in European countries.
2
Whatever we do, price controls are needed. Medical care can't be priced by a free market because customers can't realistically refuse service. I don't care if we enhance the ACA or build "Medicare for All." Everyone needs to be covered without employers having to do it, and prices need to be controlled.
Implementing Medicare for All would require a long, complex transition. The first step might be enhancements to the ACA. It is a false choice to hold those things in opposition. I wish the media, and the candidates, would stop doing it.
2
Most of the hand wringing over a candidates political positions is premature.In our legislative system, what seem to be radical proposals are modified to better fit reality.But...you start out with the proposals in order to get the public's attention.This was the path to Obamacare.Obama started off advocating a single payer system if you recall.The same dynamic is occurring with the "Green New Deal"...it is a beginning...a proposal...not the end product.I remember that your position on Obamacare was that it was a good beginning which would lead to a better healthcare system because it got the publics' attention.You were right...so don't worry so much about what the candidates say now...I think politicians have a tendency to change their positions to better fit what the polls tell them.Don't you?
1
"Others, like Switzerland and the Netherlands, have a large role for private insurers."
Correct me if I'm wrong, but as I understand, these countries not only tightly regulate the industry, they do not allow insurance companies to make a profit on basic services. Until Biden, or anyone else, decides to back a plan that removes the incentive to bilk patients on critical care I'm going with Sander's single-payer idea.
5
Thank you Mr. Krugman for having a unifying tone going into these debates. Always nice to see, especially since division is exactly what will get Trump a 2nd term.
There are 2 things that should be pointed out in the debate over Medicare-for-all vs ACA-on-steroids: 1) Medicare is not free. First, a person who has worked for 40 years with an average income of $100,000/yr has paid about $58,000 into the system before reaching eligibility. Secondly, using my own experience as an example, my wife and I pay Medicare premiums of $2,640/yr and supplemental insurance costs another $4,400/yr. Thus, our health care costs are about the same as when we were both fully employed. 2) Employers consider "total compensation" when considering how to pay their employees. A sponsored health insurance plan may be costing the employer $12-16,000 for an employee on a family plan (two or more people); the employee is also responsible for premiums and out-of-pocket expenses that amount to $6-10,000/yr. Now, if you have Medicare-for-all, someone has to pay in an on-the-go fashion, i.e., there is no upfront investment by the employee through yrs of contribution. But consider this, with a single payer system, the employer no longer has to make the $12-16,000 contribution; this 'found money' could go to either the employee, who would be taxed for health care, or to the government as a tax to pay for the health care system. Either way, the pot of money is already in the system - Sanders should point this out.
3
@Robert
Under Medicare for all, there is an upfront investment through years of contribution - via taxes.
And if you think that the $12K-$16K an employer saves means that you're getting that padded on to your salary, you are adorably naive.
You think Canadians earn $12K more than Americans because employers don't have to pay their healthcare? No.
In many instances, especially for high tech work, they earn significantly less than Americans. Most Torontonians bear Manhattan living costs with Ohio salaries.
From article:
"Unfortunately, Biden and Sanders will be appearing on different nights during the next Democratic debates. So it will be up to other candidates, or the moderators, to put them on the spot. It’s time for both men to stop poisoning their own party’s well."
This is the least of the defects of this early vetting of candidates by the Democratic National Committee chairman. To give a spot to Maryann Williamson (sp?) and exclude from the first round seasoned elected officials is an absurdities, as is asking them to "raise their hands" on positions, which degrades candidates for the highest office in the land.
So, sure, they are forced to get attention, which is to go for the most extreme positions that will be featured in the media. None of this faces the test of reality, the mind boggling complexity of health care in a era of medical breakthroughs and increasingly aging population.
At least the proverbial "smoked filled room" did choose those who had made a career in the political morass, and shown they could win elections while deliviering that sausage that outsiders never see being produced.
3
Medicare for all, at least the way Medicare works now, would still require private insurance. Medicare by itself doesn’t cover nearly enough. In order to get coverage comparable to employer based insurance there are two options, either a supplemental policy or Medadvantage. Both are provided by private insurance. I don’t know how you would give everyone Medicare without the private health insurance companies. The cost to taxpayers would be astronomical. I wonder if Bernie Sanders and Elizabeth Warren know that. I certainly haven’t heard any discussion of it. As I see it, doing away with private insurance would be economically disruptive and unpopular, not to mention expensive. Even so we have to figure out how to cover everyone in a way that makes health care available to everyone at a cost that even the poorest can afford.
The Netherlands is a fantastic country in so many ways. Healthcare is not one of them. They don't actually believe in healthcare; that is, they don't believe in treating ailments. There is a joke in the Netherlands that your arm has to be hanging by a thread for them to let you in the hospital.
As an expat there, I knew several people who were on the verge of hospitalization before they were prescribed antibiotics. Another example: both a drugstore employee and a doctor scolded us for wanting to put just a little bit of hydrocortisone cream on our baby's raging eczema. It's not available over-the-counter (as it is practically everywhere else), so I had to rent a car and drive to Belgium to get it -- a common practice.
I agree with your larger points, but I cringe anytime a writer looks to the Netherlands as an example of a functioning system.
1
You don't understand what's going on here. You are talking nonsense. We are not giving everybody antibiotics right away, because that leads to antibiotics that don't work because of bacteria that got resistant to these antibiotics. The joke you mention is different from what you think - we are afraid that too many of your countrymen would emigrate to our country. So there you are. You are welcome to come back, even if your leg is about to be amputated. We will surely help you, even of you are penny less.
1
Thanks Paul, as usual, for your clear and concise explanation of a complex issue. I hope voters are paying attention.
If you go into MI, Wi, and PA and start talking about Medicare for all via higher taxes and taking away all private insurance, you will lose those states. And we cant afford to lose them.
Also, you will be telling the 2 million people working in the insurance industry that they will be losing their jobs. Can the Dems afford to turn off 2 million voters automatically? The answer is: no.
1
Thanks as always, Dr. Krugman, for an intelligent and understandable critique of Biden and Sanders and their plans for health care. What a foolish moment in that last debate when the moderator asked for hands to be raised for health care for all, or for immigrants/refugees. We're not talking about that yet, and that's simply another scare tactic to go along with the buzz word, SOCIALISM. What year is this? What would it be like to live in a country where medical care is possible if that's all available for you? If you work for a company that has good insurance, why should that be dropped? That should not be part of the discussion at this fraught time in the election cycle. Along with space, or pie in the sky. Jobs, roads, bridges, and yes, stop poisoning the well. I blame Sanders for this who hooks up with the Democrats when he needs to like USA does not on the Soviet rockets. It's all too ironic.
Yo, Biden is NOT going to be the nominee. It's ridiculous to think he is. Why would he succeed now, when he's both old and most at odds with where the grassroots of the party is, when he's failed before with much better odds?
Frankly, Sanders was too cozy with Hillary last time around, and I think he's determined not to do that again (I don't think he'll be the nominee, either).
Finally, you don't really make any case that the European countries with blended public/private health care don't fall victim to corporate greed in the health insurance sector. I'm willing to believe that, but I'd like to see some evidence.
Bernie and his hardcore followers seem determined to reenact the Charge of the Light Brigade. Bottom line: "Medicare for all," which would take away private insurance from 180 million people, is a suicidal proposal that guarantees the re-election of Donald Trump.
3
“More than 100 million Americans are covered by Medicare or Medicaid, which are both single-payer programs”
Really? I’m on Medicare and was frankly surprised at how complicated AND expensive it is. I pay for Part B ( and the IRMA, which is income related), a supplement ( which is totally necessary ) and a prescription plan ( again totally necessary). And now Sanders wants me to pay more taxes on top of all that. Someone needs to be honest about medical coverage and how much it costs and stop the simplistic blaming of “corporate greed” for everything.
2
Just a reminder - Democrats destroyed the Republicans on healthcare in 2018 by simply protecting and expanding the ACA. Winning the election in 2020 is infinitely more important than what you personally believe the ideal program might be.
Ok, you want Medicare for all, then let's get rid of all the free healthcare coverage for politicians and government workers and unions. Put everybody on the same plan, and make them pay for it.
2
Medicare for all is DOA. It will never happen. Ever. Americans will never give up their employer sponsored health plans unless forced to do so, and the party responsible would be committing relative suicide in the process. We don't need to burn down the house to fix the plumbing.
1
The problem with employer sponsored plans is that they can make it difficult for people to change jobs or start small businesses. Employer sponsored plans should eventually go away. I agree, however, that making such a shift will be a long, delicate process. I wish the candidates were clearer about their transition plans.
2
Stop poisoning the well? You want the Democrats to stop their circular firing squad and start finding ways to BEAT Trump and take back the Senate?
But that might cost the so-called Democratic "Leaders" their power, and, for them, there is nothing worse than that.
Nancy Pelosi can be the lightning rod for ALL Democrats, Liberals, Progressives, and even Democratic Socialists, if she'll just start taking strong intransigent steps to curb Trump's expanding excesses and power-grabbing. But she won't, playing backroom politics.
Bernie Sanders needs to make up his mind: Is he a Democrat or not? The "leaders" are afraid if he's forced to make a choice, he'll mount a 3rd party campaign that will ENSURE Trump's re-election.
But how realistic is that? Sanders attracts a significant minority of people who also are /were attracted to Trump. Are they really going to vote for a Democrat if Bernie folds his tent?
But Biden, while popular, is showing why he's a poor candidate. He's just clumsy, for lack of a better word. Clumsy. What does he stand for? His last 10 years from the day Obama tapped him on the shoulder? Or the years before that, which aren't appealing at all.
There is a place to go to find the best answers on Healthcare, and, surprisingly, it's with one of the big, fat corporate insurance companies. Remember how when the ACA was first launched it was a flop, then systems began working? That was one company, rewriting and fixing software that made the ACA work....
They are both a 100, what did you expect. The democrats need youth, energy and new ideas. I’m with The Squad.
2
In Canada - the government also runs hospitals and pays doctors.
2
Dear Sir, What you don't address is the "for profit" oil sludge that is now the ACA. Understaffing of nurses and doctors at hospitals and clinics that are top heavy with administration; house size loopholes that require services be within system but don't provide that treatment ie dialysis; supplemental plans and drug plans that pay for nothing; drugs that cost $2 to make but cost $60 a month (& no R&D in 40 years); and drugs that cost a fortune here but pennies in every other country. People have been begging for Single Payer since the Eisenhower Administration. Do you think there should be a "purity test" after 70+ years of Congress sleeping with For-Profit-Medicine while life expectancy drops to Third World levels for many. Biden doesn't get it. He is vested in his "baby" & not the people in need. This is a shaming commentary that says we should be satisfied with less instead of asking for more and better healthcare for all the people no matter their race,gender or economic status.
4
As it stands today,Biden is the most electable.
All the polls show it.
We are trying to cope however with EXTRAORDINARY times!
I believe what Krugman is saying is that in order to get rid of the amateur in the White House we Democrats must emphasize
ELECTABILITY as the highest criteria and not deal, at least for the time being with details.
We will never attain any changes,
IF WE DO NOT WIN THE ELECTION!
We should be functioning in an EMERGENCY mode.
I don’t know about the rest of you, but I have felt miserable ever since January 20, 2016....................
2
Democrats want everyone to be covered. Republicans don't. It IS that simple.
7
Don't you wish we could have Paul Krugman moderate a debate between Bernie and Biden, just on health care? We might actually get somewhere and learn something, for once.
1
Only your opinion Paul and I learned not to trust that in 2015/ 2016. You are all behind neoliberals and status quo.
Very simplistic opinion and outline of the plans. You do us Americans an injustice and are helping the republicans become winners again.
We're the wealthiest country in the world and our republican policies with the help of democrats have produced how many more billionaires over the last 20 years. Multi billionaires, multi millionaires by scamming the public tax payers dollars and outright robbing our pockets. They have the power to buy every politician and government official which zeros out we the peoples vote. They even rig elections in countires across the shining seas that supposedly in we the people and. Huh?
2
Biden is a closet republican.
From his stance on busing, to the crime bill in the 90's, to the 2005 bankruptcy law, he's proven that he doesn't stand for democratic ideals.
He's more vile than tRump.
5
How refreshing to read an election article actually about policy rather than the current polling in some county in Michigan or what some low information voters in Wisconsin think. Maybe your colleagues will follow your lead... Just kidding, we all know it’s going to be wall-to-wall horse race nonsense from here until next November.
1
“Americans borrowed an estimated $88 billion over the last year to pay for health care, according to a survey released on Tuesday by Gallup and the nonprofit West Health.The survey also found that one in four Americans have skipped treatment because of the cost, and that nearly half fear bankruptcy in the event of a health emergency.” https://www.nytimes.com/2019/04/02/health/americans-health-care-debt-borrowing.html
The US healthcare system is a ridiculous embarrassment.
The richest country in the world spends more on healthcare per capita and as a percent of GDP and doesn't cover everyone, and those it does cover, it often does so poorly and gets worse outcomes than other countries.
Sanders, Biden, debate, argue even, about healthcare and much more!
Don't succumb to fear of fierce fact based argument.
Democrats pandering to the corporate Establishment will make Trump look strong and bold.
President Bernie Sanders 2020
A Future To Believe In
4
It's painfully written on both their faces: two old men, two warriors, who were calculatingly passed over, for the same corrupt woman. First, Biden, Obama's trusted sidekick, shuffled aside for the "agreement" Clinton held Obama to: she would be his 'heir nominee' in a staged Rose garden visual. Then Bernie, ever loyal to the DNC, until he and all of us saw the duplicity,and underhandedness of (the agreement) and money to Clinton.
I feel deeply for both of them, as time has passed away, with the world more dangerous. I see their existential pain.
2
“It’s time for both men to stop poisoning their own party’s well.”
Sanders is not a Democrat. Never has been. His pied piper shtick is wearing thin.
2
Professor Krugman you perpetuate the flaw in this debate—that it is, and should be, about insurance. No, what we want, and what our economy is quite capable of delivering is health care—for every person who needs it. The conversation should be about universal health care—and how to have it at much lower cost. I suggest you as an economist help lead us through the weeds of the economics. Educate us about how much we pay compared to how much we should have to pay, i.e. what people pay in other countries. And please stop rebroadcasting the scare tactics from the insurance-medical establishment—“whoa, you’re going to have to pay a lot more in taxes.”
3
I have never understood why, in this country, employers are responsible for their workers' healthcare. It must be a terrible burden and, of course, we consumers pay for that health care when we purchase their products, don't we? It's all figured in or they couldn't stay in business.
Also, wouldn't more people with that great American entrepreneurial spirit start their own companies if they weren't concerned about losing their health care? And they could hire people and not have to worry about their health care! More time to manage that great new company and hire more people.
I just don't get it. Any business people who can explain this to me? And, if you are a business owner, do you want to be responsible for your workers' health care? I don't believe we've heard enough from the job creators on this subject and I would appreciate any response to my query.
6
The goal is Universal coverage that actually allows broad access to health care providers.
Bernie acts like Medicare covers everything. It doesn't. About 90 percent of Medicare recipients have private supplemental insurance. Medicare also processes medical claims through private insurance companies.
Medicare for all without private insurance companies is a complete fantasy.
3
Medicare for All level reimbursements would bankrupt a large percentage of the hospitals in this country.
3
Dr. Krugman is correct. Politicians just can't seem to shake the habit of spinning everything. Democratic politicians need to do so. They need to become the politicians that people can turn to for reality-based statements and policies. They need to be able to differentiate between what they'd most like and what they think they can do. They need to make clear that we need Democratic majorities (preferably large ones) in both houses of Congress and in as many state governments as possible to get major proposals enacted and carried out. Of course, being plain about such things goes against all the on the job training of politicians, but we don't live in normal times, and politicians need to rise above their Pavlovian responses. Joe Biden shows constantly that he's not capable of doing this, and Bernie Sanders, especially this time around, has been doing similarly, as Dr. Krugman points out. Senators Harris and Warren do indeed need to take heed, especially because their own records, while better, aren't spotless. So do the other candidates, if we're meant to take them seriously. And everybody, please don't be afraid to admit when you've been wrong, and to apologize.
1
Bernie and Joe are too old and each carry too much baggage to make a formidable run for the Presidency. I think Trump would be very pleased to run against either of them. Biden the presumably safe choice is anything but--Bernie's madman socialistic bent just won't play for most Americans.
I hope the Democrats can come up with a credible alternative to Trump. I know its early but so far I am not confident this person is included in the current pack running.
We need leadership. To date I have only seen a pack of unimpressive candidates who pander to each group that are addressing.
Its time for new, fresh and most importantly realistic views spoken from the heart that will resonate with everyday Americans.
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Fifty years ago this past Saturday we put a man on the moon with less computing power than in a smart phone, yet somehow we cannot figure out a decent, workable system that insures that the citizens of this country have access to affordable health care? We can prosecute a never ending war in the Middle East for over 16 years, wrecking countless lives, and causing innumerable deaths, but we can't afford health care for our citizens? This is what Democratic candidates need to be pointing out instead of fighting amongst themselves. It is a matter of priorities, and unlike the moonwalk, this does not involve rocket science. Other industrialized countries have made providing access to affordable healthcare all its citizens a priority, long before we walked on the moon.
Surely we can look at various systems that work well in other countries such as Switzerland, Germany, and Canada and devise a system in this country that is workable. If everyone pays something in, then it reduces cost, and if everyone is covered, then risk is spread. Like the optional supplemental insurance I pay for with Medicare, universal healthcare coverage should have an option for supplemental coverage as well.
President Roosevelt gave us Social Security. President Kennedy aimed at the stars, united this country in purpose and we accomplished the goal of putting a man on the moon. President Johnson gave us Medicare. President Obama gave us the ACA. Yes we could, yes we did, and yes we can do healthcare.
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One thought of "selling" Universal HealthCare, whether Medicare for all or another combination of coverages, is that all insurance plans' costs are also a health-care tax. Only now the taxes paid just go to the private sector and not the government. So we're going to pay one way or another.
Taking Medicare for All still sets up the public 'having to pay' the private sector the other 20% that isn't covered by the current program. So the initial monthly premium goes to the U.S. Government, then all the deductibles go to the individual who is being taxed furthermore with Co-pays per visit to all provider visits plus all procedures that may come up. This includes diagnostic X-rays, MRI's, Labs, and any procedures that are required to be done. Then Part D meds all have a separate but similar out of pocket costs.
Adding up all these costs per Annum is your personal yearly medical tax. Whether or not you pay it to the government or the private sector it still comes from the same source: your wallet.
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Just a reminder: In practice, Medicare is not single payer. All recipients need to purchase a supplemental policy from a private insurer in order to provide complete coverage; otherwise they may face costs that may bankrupt them.
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@rss
Single payer says nothing about the extent of coverage or what is covered. You think Canadians don't pay for their medications out of pocket if they don't have insurance? You think government covers hearing aids or dental care? No, they don't. And people aren't covered for those things unless their employer provides them with a benefit plan. Buying insurance as an individual means that you're out at least $300/month - and that typically only covers drugs.
According to Krugman Medicare for All would "enhance current recipients' benefits." But he doesn't defend this assertion or say how it would. On the face of it, it seems like Medicare for All would be a net loss for people already on Medicare. Any increased taxes (increased middle class taxes, increased inheritance taxes, increased financial or stock fees) that hit the 100 million people already on Medicare would in effect reduce their existing Medicare benefits, since it would cost them more to get the same benefits.
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Excellent column Mr Krugman – this one was needed.
IMHO, Sanders’ proposal goes against Kanehman’s loss aversion decision theory. It won’t work. Biden’s proposal, although somewhat fuzzy, might be the middle of the ground course.
Democrats have a grave responsibility in the 2020 elections. If Trump wins – the damage will last for one or two generations.
Egos must be set apart but, unfortunately they are human beings who have lots of them.
The Mueller testimony will be a “rehearsal dinner” of their personality.
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I agree entirely. This kind of ugly fighting only works to Trump's advantage.
Let me add a couple of things you didn't mention, Prof. Krugman.
First, the elephant is the room is the vast lobbying power of the insurance industry; medicare-for all-becomes a fight for survival for them. No chance whatsoever they would lose - not without vast campaign reform first. Medicare for all is never-neverland thinking.
Second, as I recall, the ACA required insurance companies pay out most of premiums as claims - I recall something like 85%. After administrative costs, how much is left for profit? Certainly less than 10% and maybe more like 5%. So cutting out profits puts only a slight dent in insurance costs.
The problem is not the cost of health insurance, the problem is how much we pay for medical care – way more than other developed countries.
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Medicare will have to significantly increase its reimbursement rates if it is to become the only source of payment for health care. Please NYT interview hospital administrators across the country and see if any could survive just on medicare reimbursement alone. Private insurance, which pays significantly higher rates, subsidizes medicare and those without coverage. Medicare for all could work but it needs something like a 20% VAT tax (think national sales tax) to pay for it. Like every European country with a national health care program.
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The argument between Medicare for All and expanded Obama-care is a good one. I prefer phased in Medicare for All, leaving a role for private insurance, as Medicare does now, until insurance stockholders find greener fields.
Can Biden explain why he thinks a public option (Medicare for Some) which is a form of single payer, is not going to eventually lead to Medicare for All?
I see, as Krugman does, the potential for disaster in this argument but am more sanguine. Once we chose a Presidential candidate, his or her plan will compete against Trump-Care, AKA No Care or Rich Care. That's a likely win for the Dems.
Has everyone given up in challenging big Pharma and its ugly cousin, big Insurance? Both parties talk around the subject. We have the most expensive medical system in the world. US tax payers and citizens are subsidizing lower medicine costs around the world. Have you looked at how bad our medical services are, even for paying customers? I've gotten better treatment in socialized medicine France than in America.
This is America. We built unGodly things everyone scoffed would fail. We put a man on the moon. We united a country full of strangers and made democracy work for all. Now, we're afraid of a bunch of oligarchs milking us dry for pills.
Just recently, the Washington Post (and others) broke the story of the opioid epidemic. The last few years, we've had stories on the collusion between the DEA, Big Pharma, both political parties, Congress, hospitals, drug retailers, etc.. So, why should we expect anything different from establishment candidates of either party?
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I know it seems silly to think of taking into account the opinions of people who actually do the work of caring for people's health, because of course, economists now know everything, but has anyone thought to ask doctors-or nurses how the system works or ought to. I'm just an old country psychiatrist (and a medicare patient) but from younger people's blogs the picture is dire.
Ask why there's so much burnout, so much depression among medical personnel. It's because corporatized medical care which is run by the insurance companies that Biden et al, venerate, endorsed by Dr. K., have commodified medicine and taken the autonomy which is the heart and soul of practice.
Obamacare and its electronic medical records are killing medicine. I'd gladly have taken a pay cut of 25% not to have had my practice dictated down to the particulars by insurance companies and their goal of providing less service for their management's greater profit.
I finally gave up to save my soul after 58 years of practice. I'm sorry for the younger people some of whom have never known what good conscience driven, not insurance driven practice can be.
I'm not a big math guy but I figure medicare for all with administrative costs of 3-6% is cheaper than private insurance with profit margins of 18%. Tell me why I'm wrong Dr. K!
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"...the Sanders plan would require that roughly 180 million Americans give up their current private insurance and replace it with something different. Persuading them that this would be an improvement, even if true, would be a tall order."
That would be a great argument - if it were true. polling indicates that it is not true.
"55% of voters back a Medicare for All system that diminishes the role of private insurers if they retain access to their preferred providers.
"Independents are 14 points more likely to back the system when told losing their private plan would not mean losing their doctor (42% to 56%)."
https://morningconsult.com/2019/07/02/majority-backs-medicare-for-all-replacing-private-plans-if-preferred-providers-stay/
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See the “if,” part?
They might’s well have asked if you’re in favor of eating all the cake you want and never getting fat.
And I guarantee you: you go to the people I work with (and I kind of represent them when it comes to health benefits) and tell them that you’re taking their current bennies in exchange for higher taxes and a government plan, and...well, you best have yer track shoes on.
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@Ed Watters
That poll never specified what "diminished the role of insurers" actually meant. Page 353 is the question they asked. https://morningconsult.com/wp-content/uploads/2019/07/190675_crosstabs_POLITICO_RVs_v2_BH.pdf
Diminishing the role of insurers can mean a lot of things. It can mean the insurance company no longer gets to decide if they're going to cover a specific thing.
It can also mean that if you want to sue your healthcare providers for malpractice, you get a capped settlement (if you get one at all), and no lawsuit actually takes place.
In regard to the single payer proposal we have all heard the complaints about the British National Health System and its Canadian counterpart and while the complaints may be somewhat overstated, luckily we have a smaller scale operating health care system in this country to base some judgments on as to how government provided care will work. And it's a system that is designed to care for our most honored citizen so it should be as good as it will get. It's called the Veterans Administration Health Care System, and over the years this paper has had cause to write a lot about it and none of it was good. People waiting months or years for an appointment, dying untreated on gurneys in filthy hallways in crumbling facilities. Yes, you should expect that when you have no competition and no alternative we'll get VA quality care writ large as your health care.
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Weird, given that the NHS produces better patient outcomes and member satisfaction cheaper.
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@Robert Weirder still that "member satisfaction" is a totally unscientific metric that doesn't mean anything.
Basic common sense tells you that only a small portion of members are sick enough to use the system frequently. And if you're being honest, these are the people who experience the health system actually means something.
People are unsatisfied with the VA precisely because their patient population is almost exclusively filled with people who use the system frequently.
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Oh...you don’t have a checkup every year or so? Never get your flu shot, an eye exam, your teeth cleaned?
My point was, the claim that no government-runnsystem could possibly work is just plain nonsense, as the NHS demonstrates.
And the prob with the VA is not generally with the docs and services. It’s getting to them.
"For his part, Biden is declaring that the Sanders plan would undermine Medicare. In fact, it would enhance current recipients’ benefits. And it’s a bad sign that Biden, who poses as Obamacare’s great defender, is using a G.O.P. scare tactic familiar from the utterly dishonest campaign against the A.C.A. No Democrat should be stooping to that level." Mr. Krugman, another GOP tactic is to make a statement without supporting facts, which you just did. How would it enhance Medicare? What is the scare tactic? The really scary thing is alienating 180M Americans who like their health insurance.
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I know it seems silly to think of taking into account the opinions of people who actually do the work of caring for people's health, because of course, economists now know everything, but has anyone thought to ask doctors-or nurses how the system works or ought to. I'm just an old country psychiatrist (and a medicare patient) but from younger medical people's blogs the picture is dire.
Ask why there's so much burnout, so much depression among medical personnel. It's because corporatized medical care which is run by the insurance companies that Biden et al, venerate, endorsed by Dr. K., have commodified medicine and taken away the autonomy which is the heart and soul of practice.
Obamacare and its electronic medical records are killing medicine. I'd gladly have taken a pay cut of 25% not to have had my practice dictated down to the particulars by insurance companies and their goal of roviding less service for their management's greater profit.
I finally gave up to save my soul after 58 years.
I'm not a big math guy but I figure medicare for all with administrative costs of 3-6% is cheaper than private insurance with profit margins of 18%. Tell me why I'm wrong Dr. K!
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Health care is the third rail of American politics. In 1849 Hooker said that the American public is both hypercritical and overweeningly dependent on American medicine. Nothing has changed. American value AUTONOMY and fear DEPENDENCE. Contemplating a visit to the doctor is just a little less troubling than a visit to the dentist. This is why no one complains about compulsory auto insurance but compelling healthy people to buy health insurance in UN-AMERICAN. Dems need to be careful about Medicare for all. It is just another mandate. Slow and easy is a better plan.
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This article presents the situation as one in which both sides present only deceptive reasons for their positions. Sanders' harping on corporate greed is not the most convincing argument. However, he offers several other reasons.
A main reason is that a single payer system is the most effective way to cut costs. It gives the government power to negotiate prices. Curbing runaway cost of healthcare is a major benefit to the single payer system that Sanders proposes. As other commenters note, the US pays over double per capita than any other nation without covering everyone. These runaway costs are probably not sustainable in the long run, which means our healthcare is bound to get poorer over time when privately funded. The only way to maintain insurance companies are profitable is to cut access--something which many people are currently experiencing, and sometimes dying from.
A second reason for single payer is that ensuring everyone is covered by the same system necessarily puts democratic pressure on the system to be maintained and high quality. This significantly reduces the chances of GOP sabotage. If the wealthier can opt out, this increases the likelihood that the system will be regarded as a type of welfare, subject to future cuts, and the political rhetoric of resentment.
33 million are not covered by the ACA at this point. Why believe 'tinkering' is still the answer? The proposal is popular. What makes it an electoral loser?
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The debate between either the new and improved ACA or "medicare for all" is a good one and no matter who the Democrats pick I will vote for them and let them sort out the details later. IMHO the new ACA is a poor choice. Supporters are banking on the public option to be a start on the road to "medicare for all" but it will take 50 years to make a dent in the control the insurance companies now hold. Actually I fear it could be the undoing of any hope of change in our health care system. But if history shows us anything the single payer nay sayers will continue to undermine the ACA as they have been doing, which means the ACA continue to bang pop and wheeze along and never be as good as it should and this will be the attack angle to kill it again and again. Until the single payer system puts the insurance companies, their paid for reps in Congress and all the lobbyists in their proper place of influence, none, they will continue to bribe , intimidate, lie and anything else they can do to destroy good health care. The longer we take to do this the longer they have to stop us from moving from, as one commenter put it, from managed illness for profit to managed health care for better health
Name calling and distortion when you disagree is fairly normal, but I'm glad you took them to the woodshed for some "education." The airing of possible policies, and disagreements about their quality, is a useful part of the political process. We're all scared of doing anything that would help Trump win, but we shouldn't worry about that. Whatever mistakes the Dem candidates make now will be as the gentle fall of a spring shower compared to what Trump and Putin will throw at the eventual nominee.
Right now, most hospitals are barely scrapping by. Though insurance companies may be making lots of money - health provider aren't.
Health providers look to be getting by because they can charge private insurance companies and non-insured patients more than Medicaid and Medicare. Who decides how health providers can survive - or what should healthcare cost? What costs do we have to bear to make healthcare accessible to all Americans, especially rural America? This is complicated. I hope we quickly use a public option so those who need coverage can get it. But to think we can write one bill, implement it in 2-4 years, and bam it's fixed seems way to simplistic. And to keep trying to sell Medicare for All as if NO private insurance is involved, ignores the current system. But it's clear private insurance are gatekeepers against affordable, accessible care. Medicare does it with regulated prices and power over care - and yet private insurance companies still want to play. So, why is there a role in Medicare for private insurance - what are the advantages to their role?
That's why we need a real conversation - not my plan or no plan rant.
It's still way too early for me to decide who the Democratic candidate should be. In 2016 it was Bernie Sanders. Now I am open to considering some of the other candidates who deserve to be heard. Health care and medical insurance is a big concern for the majority of Americans and neither Sanders or Biden have all the answers.
I submit that health care costs are at least as serious a problem as coverage. Any Democrat needs to undertake a serious effort to cut those costs. Healthcare is now $3.5 trillion annually or 19% of GDP growing at about 3.5 times inflation.
The causes are pharma prices, doctor's income, insurance inefficiency, hospital costs and monopolistic practices.
If our healthcare cost the same as France, which has more coverage and better outcomes, we would save $1 trillion annually, which pays for all kinds of things.
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On the one hand, we have the patients, on the other, which no one addresses, is how we will attract new doctors. Today, a number of first rate medical schools are offering tuition free education, because the lure of a secure financial future isn’t there. Paperwork is drowning medical practices, and the insurance payments received by doctors isn’t enough to justify their years of training. This is a real conundrum, but the European countries made it work. Surely we don’t need to reinvent the wheel.
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"There are, broadly speaking, two ways a country can try to achieve universal health insurance", and both of these ways are, broadly speaking, very much "in the box" thinking. Why not bring the market to bear by having everyone pay for their own healthcare out of pocket, whether that be a doctor's appointment or choosing a private insurance plan. Tie that to a universal (yes, single payer Federal insurance ) plan that, based on income and focused on preventing economic catastrophe, reimburses the individual for all medical costs beyond a certain threshold. In effect a progressive deductible that insures everyone will pay what they can afford, but no one will go without. Progressive values of universal coverage--check. Conservative values of true market driven economics and personal rather than governmental responsibility--check. Out of the box--check. Broadly speaking a third way--check. Chances of enactment--unfortunately zip.
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We are all subsidizing employer-based health insurance in the prices we pay for goods and services, as well as the individual income taxes we pay to supplant the shortfall from corporations that reduce their tax bills accordingly. Plus, anyone losing a job, COBRA notwithstanding, is a risk of being uninsured, along with their dependents. Let's sever the relationship between employment and health coverage: tax revenues would equilibrate and consumer cost of living would decrease, while coverage would grow.
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I think a solution that has never been proposed should be tried. A tax on healthcare policies that covers the cost of national pre existing illnesses on all private healthcare plans. I would also keep the coverage that includes children under 26. The biggest objections to the ACA involve the high cost people without subsidies pay to cover those getting help. Congress should also pass tax credits for those working that cant afford to purchase insurance at there current jobs because of the cost. That’s cheaper than subsidizing them on the ACA. Increase the Social Security and Medicare taxes to cover the program to the end of the century while ending all income limits. Require the tax to include capital gains. Sure, it will hurt the companies that offer healthcare and their employees. It is a lot better than any of the proposed changes Democrats are offering as a solution. Both parties should yield to this type of solution that would also get coverage to states that didn’t take the Medicaid help. The consequences of no ACA, or Medicare for all is to scary for either party to risk.
As long as there is a limit to SS benefits there needs to be a relevant limit to wages subject to withholding. Otherwise, SS will no longer be Old Age, Survivors and Disability Insurance (it’s actual legal title).
@From Where I Sit. If it was truly insurance, I would agree. It isn’t. Premiums should be adjusted according to variables. Currently, the premiums have nothing to do with life expectancy, or the amount being distributed. The current provisions are more akin to a Ponzi scheme. Even without the amount the government “borrows” it is on a course of insolvency. Changing premiums, reducing benefits, delaying eligibility, or increasing taxes to subsidize the existing program are the only choices. Inaction will only lower premiums by law. It would be better to include the healthcare problem with Social Security insolvency at the same time. All of the solutions stink of increased taxation. The question is, will congress do something before benefits are reduced, or the ACA completely fails? Then what?
@Jay Correction, inaction will only reduce benefits by law.
The first ever health 'insurance' for blue collar workers was started by that evil 'socialist', Otto von Bismarck, aka the Iron Chancellor of Germany, for political reasons in the mid 1880s, and in the same decade followed by a accident insurance and old age social security one for the same group.
That model was followed by other European nations starting in the early 1900s, and built upon until almost all of them had universal healthcare.
All these nations spend at least less than 1/3rd per capita on health care than the still richest nation in the world, while also having a healthier population over all, including a longer life span, less obesity, less mothers or babies dying during childbirth, less unwanted pregnancies and abortion, and the list goes on an on.
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While I believe that Medicare for All is the best solution, Americans will have to come to that understanding themselves.
Let's pit private insurance with a well-funded Medicare public option. The public option must work as single payer--without co-pays, deductibles, co-insurance, in and out of network, etc.
Americans will soon figure out the private insurance they so prize is built around profits for insurance companies.
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I am always frustrated when I read about health care options and costs and no one ever discusses the Health care premium exclusion. The cost to Federal government is about 250 billion PER YEAR in lost revenues. To provide a comparison the Mortgage interest deduction costs about 70 billion a year. How can any serious discussion of health care not include this in the analysis.
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Most of the Democratic candidates are members of Congress. How many would be willing to give up their congressional health plan for pure Medicare with no Advantage supplement?
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The election starts when the party conventions choose their nominee. Ask the vast majority of Americans what any candidate is saying and they won't have any clue. Trump will dream up and pin a failed plan onto any Democrat while touting his big, beautiful hospitals.
Instead of wasting words on criticising the debate and the bit of slagging that goes along with it, use the space for writing more about the merits of each plan. The public needs to have a solid grounding of fact based information around health-care plans to clear up misunderstandings around the vocabulary of insurance, meaning of universal and who foots the bill. Please, expose one self delusional public perception that anyone really likes dealing with their insurance company. When the government is the insurer, there is no nasty paperwork and no arguments about co-pay. People with private insurance will see an improvement in their lives because they don't need to consider health insur when moving jobs, worry about their older children, increases in premiums, retirement or the conditions placed on renewing policies. Another delusion is that with private company insurance you get to see any doctor you wish.
We got into the trouble we are in now with Trump because the public is not educated on the facts. Less worry about dire predictions and more discussion of the benefits of solutions to obvious problems. People are scared because they don't see the way forward. Fear makes Trump powerful.
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My 91 year old mother pays a $300 a month Medicare premium and another $500 a month for a personal physician she can see on call. Many physicians refuse to accept Medicare because the repayments are so low. She would have to pay an additional Medicare supplemental premium (part B) as well except my father was a WWII veteran now deceased who had Tricare for Life which isn't even offered to soldiers anymore. So when Bernie or anybody else tells you there are no Medicare premiums or copays or deductibles, he is not telling the truth. And when Biden claims he's going to improve Obamacare, he's also not telling the truth. Obamacare is a horror for people who don't get subsidies like me. A $700 a month premium with a $6,000 deductible. At least my mother is covered and safe. If I get sick I will be bankrupted. Both systems are a nightmare. Check out Beto's Medicare for America plan. Better than Bernie and Biden's plans combined.
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@ekdnyc does your mother have a medicare advantage plan? the payments you are quoting don't make sense for the traditional medicare which is part a - no charge, part b - about $140 a month, higher if you have a high income. then you have the additional plan d for drugs, and a supplemental medicare from a health organization which varies depending on where you live and which companies offer plans.
We need a plan which guarantees a minimal basic coverage for Americans and legal residents. The key work is minimal. The candidates are dishonest about what they stand for, if they even know themselves. Do they support, free unlimited government funded care? What won't be covered. Will everybody with a "disability" get a free home health aid? Free experimental cancer treatments? Unlimited counseling? If your first liver transplant fails, do you get a second? Today, it is common to spend as much for medical care in the last year of a person's life as was spent in the first 80 years. It is fiscally unsustainable. It is a medical Ponzi Scheme. Doctors, hospitals, service agencies and pharmaceutical companies rape the government and insurance coffers. It is best when private citizens make decisions about how to spend their own money. We need to breakdown the medical cartels which set prices and limit service providers. We need to create an economic environment where American workers make enough money to afford to make their own choices.
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Here is another approach to paying for healthcare: Bet some money on Trump winning re-election. The level of vitriol leveled by Democrats against other Democrats in the face of solid unity by GOP voters behind Trump means that this debate will likely be rendered spurious in November 2020.
Two quick points:
People who say they like their private insurance only say that because they've never had to really use it. I don't mean doctor's visit co-pays, I mean really use it for medical emergencies. They then find out how extortionist and cruel their plan actually is.
What people are charged for care under a for-profit insurance system is not actually what care costs. This is where a lot of the panic over the "cost" of universal care comes from (with no attempt to dispel this false belief from the insurance companies, of course). For the sake of argument, you might be charged $5,000 to fix a broken arm under our system, but in no way does it actually cost that much to treat you.
For-profit healthcare is barbaric, inhumane, and indefensible. Medicare for All.
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To @ Dominic
We have used our private insurance for emergencies and so far it has been good. The fact that a broken arm costs the insurance company 5k is a separate issue and needs to be addressed as part of the overall reform of healthcare. If my insurance pays that bill and I am left with a reasonable co-pay, which so far is the case, I’m happy with that. I don’t like the fact that a broken arm costs that much but shouldn’t the insurance company be the one to scream about it?
@Kevin The stories one reads are horrible. 62% of all cancer patients in debt for their treatment? People dying from treatable illnesses because their insurance refuses to cover them? Diabetics taking road trips to Canada to buy insulin--every single month?
I haven't had these problems but I've never had a life-threatening illness. It's very possible we won't find out our insurance doesn't cover treatment until it is too late.
I don't want to have to decide between dying of cancer and sending my kids to college.
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It is true that at least two European countries have systems that allow private insurers to administer their health plans. But the countries in question really do regulate their insurance companies. These countries treat insurance companies as public utilities and regulate every aspect of their behavior from profits to required coverage. The regulations mostly favor the insured.
Is that ever going to work here? Healthcare is more than 15% of our economy and health insurance companies have lots of money. If we try to have a universal healthcare system that is run by rich insurance companies with obscenely paid CEO's what will we get?
In Europe, the government controls the insurance companies, in the United States, it is almost certain that insurance companies will control Congress and the regulatory agencies. Under those circumstances, our healthcare system will be run for the benefit of the insurance companies and not the insured. It is almost certain to be too expensive and to provide inadequate coverage. Profits will trump healthcare every time.
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Biden and Sanders are both very experienced politicians; they will say anything that they think will get them elected and will likely "change their tune" if elected. Therefore, don't pay too much attention to what you hear in the campaign; what they have done in the past is a better clue to what would be done if they were elected.
I am beginning to despair that the Democrats will not get their act together in time to defeat Trump. They need to keep their eye on the prize. They have to win over the independent voters. Trump voters are a lost cause. It would be nice to restore civility and decency to our country.
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WELL: The way I see it. Go 100% with a single payer system but if folks want to feel saver and at ease let them buy a private health policy on the side. THe reason I want the single payer over the ACA: The cost savings on keeping the middle man out of the system saves lots of unneeded expenses. IMHO
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While it is true that Medicare For All support drops significantly when people are told they must pay for it through tax increases.
There's an issue that seems to always be missing.
It's the answer to a question that I haven't see newspapers or pollsters ask anyone.
Do people really know how much their total compensation is?
People with insurance through their employer need to know the answer to that question in order to understand whenever a Medicare For All system is being discussed.
Without that information the phrase "raise your taxes" is most likely measured out of the person's perception of their take home wages.
Who in media and what Pollster will ask this question to begin a more intelligent discussion?
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@Mike Coleman
Yes, they know their total compensation because they declare it on their employer-provided W2s.
Employers also pay business insurance, accountants and lawyers that are also a direct result of other workers in the company keeping the business running.If a worker gets hurt on the job, or does something illegal, the lawyers in the company get involved.
Are you really going to sit there and argue that the insurance costs, legal and accounting costs are part of a worker's compensation? That's some Enron-level accounting.
No, Medicare is not a single payer program. A large fraction of Medicare recipients also buy supplemental insurance for part B and for part D. Sanders's plan would eliminate that in the so-called "Medicare for All."
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Medicare for all is a very important issue but it certainly isn't the only one. If they sat down together and tried to come up with a presentable solution to their conflict, maybe they could then move one to the myriad of other problems that need to be addressed.
We can't forget immigration, voter's rights, foreign policy and infrastructure just for starters.
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Not the point of the article, but I can’t help but laugh at the last line, “It’s time for both men to stop poisoning their own party’s well.” Sanders has made is quite clear in the past that he is not a Democrat, he only caucuses with them for Senate purposes. Sanders has made it quite clear that he wants nothing to do with the corporate greed and less progressive than thou Democratic party until there is something in it for him to gain – like the presidency. I’m no fan of either Biden or Sanders or the bickering between two old, rich, white men, especially when the gains that were made in 2018 were made by women and people of color. All I can hope is that whoever wins the Democratic nomination is supported completely by the other candidates who had been running. Yes, Bernie, I’m looking at you.
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@V, if bernie does his dirty tricks again, it will seem to this observer that he is some sort of enemy agent. Many targets of blame for the 2016 outcome, but bernie and his bros certainly should be given "credit" for their share of this disaster.
Biden and Sanders, Behaving Badly
A bad-faith debate over health care coverage.
“The shared Democratic position — that every legal resident should have access to affordable care, regardless of income or health status — is immensely popular.”
AND:
“There are real, important differences between the two men’s policy proposals, and it’s fine to point that out. What’s not fine is the name-calling and false assertions. Both men are behaving badly.”
Name calling solves nothing and politicians should be expected to know that. But they don’t or don’t care.
The republicans would cut millions of Americans out of any health care plan and we saw that with the proposed legislation from both the House and the Senate two years ago.
What these people in congress should be discussing is making all insurance companies, hospitals and medical suppliers Non-Profits. They should also require the medial provider organizations to have one price for services, not have a “negotiated price” for insurance plans and another, huge price for any person who has no insurance.
They should also have legislation on prescription drugs that would allow them to be imported from world wide countries to force the prices down to those of the rest of the world.
These are the issues they should be talking about, not name calling.
I'd like to see the candidates provide some numbers so we can think about their ideas about universal healthcare.
For example, a family of 4 with employer subsidized health insurance today still pays about $700 for family coverage, and that comes with a large deductible.
What if we could adequately fund universal healthcare by having that same working person pay $100 a month per family member, or $400 a month, and have no deductible?
That would be an easier sell to Americans who are wondering about costs.
Let's see those funding ideas, not just a blanket "taxes will rise."
2
True Cost Blog, dates when nations started Universal Health Care
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
UK 1948 Single Payer
Sweden 1955 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
USA 2014 Insurance Mandate
PK, have the warnings about HC For All been borne out abroad? Do their average citizens feel their taxation is worth what they get?
Discuss NYT op ed “The Fake Freedom of American Health Care”, by Anu Partanen.
3
The UK has a vast network of doctors not on the NHS, and a vast availability of private insurers ( BUPA). Not just “single payer, much more two tier.
In Canada people have private insurance for services provided by the single payer ( eg imaging) and some plans include travel coverage as well.
What is most important for the US is that being shackled to a job in order to keep coverage should be unacceptable. Both the employer loses and the worker suffers.
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@Shelley Corrin
Being shackled to a job is what keeps most Canadians actually fully covered.
Only some 43% of people in Ontario have dental care coverage, and that is because of their employer. If they leave their job, they don't buy private coverage because it's prohibitively expensive. Unless you're a minor or a poor 65+, there is no coverage. This despite the provable medical fact that oral problems is usually the first demonstrable sign of many common diseases.
If Medicare is so great why do so many of us need to pay for supplemental plans to ensure full coverage? My wife is retired and is of course on Medicare which so far is working well. However we still have the health plan provided by her former employer as secondary insurance for her and primary for me. Under Bernie’s plan we would lose that. To be replaced by what? Substantially higher taxes and no choice in the matter? I believe in universal coverage and understand that we are fortunate to have the benefits we have. However the point that Krugman makes about the 180 million with private ins. is the issue. You mean all those people have to give up what they have and may very well be quite happy with (we are) so that there can be universal coverage? Other countries have a mixed system that works. Our newly elected Democratic Congressman, who flipped a Republican seat, made the same point at a town hall meeting. A previous comment about those countries not having the massive military expense we have is true but they also don’t have 320 million people and the largest economy in the world. Also, if a massive military budget is standing in the way of a mixed system, won’t it stand in the way of single payer?
It’s not quite right to call Medicare single payer. Many people get Medicare coverage through a private insurer. Bernie needs to provide more detail about what he would do with the Medicare Advantage program.
1
@EAS Medicare advantage is a scam, meant by insurance companies to skim even more money from us. It will go into the garbage as soon as MfA rolls out completely.
1
Just ignore the two old guys.
I see Krugman’s still shilling for the private health insurers. The longer we protect and subsidize the much despised private insurers, the longer facts like this will remain reality:
“A new study from academic researchers found that 66.5 percent of all bankruptcies were tied to medical issues”
https://www.google.com/amp/s/www.cnbc.com/amp/2019/02/11/this-is-the-real-reason-most-americans-file-for-bankruptcy.html
“As a Senator in Delaware, Biden shepherded to passage a law that decimated bankruptcy protection for millions”
https://www.salon.com/2015/10/21/joe_bidens_greatest_betrayal_the_one_senate_vote_that_makes_it_hard_to_support_a_biden_run/
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@Ed Watters bravo, you’re exactly correct here! But what can we expect from an opinion writer at an MSM outlet with big money ties to insurance corps.? The truth?
The headline could have been even more alliterative if it read “Biden and Bernie, Behaving Badly”
That the NYT should call out how the Dem candidates battle it out in the primary is bunk. It ain’t gonna be swapping nice guy proposals with Trump. The Dem voters can decide who is the strongest candidate and who is throwing low blows, without the professor’s lecturing.
1
To all the Democrats running for the Presidency, Please Remember the1968 and well intentioned but hopelessly executed ideas allowed Nixon and his small group totally annihilate the democrats !
1
Now and then Krugman exhibits some courage and tells the truth. This isn't one of those moments. When Biden's record, despite mainstream media censorship, is known to most Americans he will be put aside as just another servile fraud. Krugman knows this, so this article is just another specious attack from the "Anybody but Bernie" crowd that prefers even Trump to a Democratic Socialist (i.e. FDR Democrat).
3
You are damning Biden with faint praise. His plan is "bigger and better," but would preserve . . . a lot of unnecessary cost and make it too easy for people to fall through the cracks."
And any proposed plan needs to go through our bought and paid for congress.
I say go with Bernie or Elizabeth Warren's plan which has the virtue of being factual. Then work on congress.
2
Nothing matters anymore Krugman. You are treading water waisting ink on your elitist commentaries. Trump, with the help of the squad and the booming economy, already has ensured his reelection. The demos candidates are absolite and their attempts to pull the USA to far-left, to be continued in their next debate, will just increase Trump's victory. The best the Demos can do is shut up the Squad and wait for another five years to try to win the next next election, which I doubt t they will do.
1
Why do you hate Bernie Sanders, Paul?
4
Biden and Sanders are the personifications of Statler and Waldorf of The Muppets!
https://www.youtube.com/watch?v=X6I_dKUYyI4
1
Old white male politicians behaving like.....politicians. And so it goes. This is old lady(73) is beyond fed up. They both need to head for the barn.
1
paving the way
This is bull!! Why does health care for all have to be paid for with higher taxes? Trillion dollar tax cuts for the already wealthy don't HAVE to be paid for! So it's okay to add trillions to the debt in the service of tax cuts for people who can afford healthcare, but not to provide healthcare to those who can't afford it?
Also, the half-stepping, thin as gruel, milquetoast, stop gap, half measures of the Obama administration lead directly to Lowlife Donnie. If we don't have systemic, substantive change bettering the working class, poor and elderly's lives with the next Democratic president, we'll probably get worse than Lowlife Donnie next time. Although right now it's hard to imagine anything worse, I could have said the same about G.W. Bush.
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Two weeks before my 65th birthday, I was injured in an accident, and my attempts to get medical care were like the three stooges hanging paper. Fortunately my injury was not life threatening, but it was possible I had a broken bone or two. At two different clinics, I was told that they don't take Kaiser, and that they could treat me but it would cost several thousand dollars. Eventually I ended up at a hospital that agreed to bill Kaiser. It took 6 months and I received several scary bills, but Kaiser eventually took care of it.
All three places told me that if I had Medicare, it would have been a snap.
Then, on the first day of the month when I became eligible for Medicare, I received the first raise at my job since the 2007 crash.
Apparently my employer thought they had just lost some leverage, and wanted to make sure I didn't bolt.
All this brings me to why I believe we don't have universal coverage. Because big employers don't want it. They consider the leverage over employees worth more than the premiums that they pay out.
American corporations are famous for two things: fobbing off expenses on other people, and getting their way in Washington. Yet we still don't have anything resembling universal health coverage. Connect the dots... we don't have it because our employers don't want us to have it.
Side note to Oracle: I had VA all along. You never had the leverage you thought.
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@mlbex, never have figured out why this is not discussed.
@karen: Because they don't want it to be discussed?
One of the first reforms to our search of 'Universal HealthCare' must include a provision that forbids any medical provider from refusing to accept Medicare or Medicaid. This practice would really begin to advance the goals of a 'National Coverage Program'. There needs to be a "we're all in same line" mind set. As it stands now the distinction between the class divide is underlined by the 'haves and have nots' which has been weakening our society's claim of being a "classless," opportunity for all, land of the brave, and home of the brave.
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@C. Coffey
Doctors and other providers are not your slaves. Doctors do not have to accept you as a patient except for the emergency room.
@C. Coffey exactly, maximize the risk pool, nobody can be turned away, to obliterate class. Race and class are false narratives that divide Americans so they can be colonized from within!
Regarding people preferring private insurance over Medicare. I've never met ANYBODY, working or not, who wasn't happy to switch to medicare when they turn 65. And, anybody who can afford it gets a private supplement as well - so already have a public/private system that's working. I don't know why Dems don't emphasize that.
3
So Sen. Sanders decries corporate greed in the healthcare system and "broadly hints" that Biden is beholden to corporate interests, and that's your big evidence Sanders is crossing the line in some sort of underhanded manner? Give me a break. If anything, the only bad-faith behavior I see is Krugman's consistent, well-documented, and mendacious attacks on Sanders in column after column dating back to the 2016 race.
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I watched the movie "Black 47" last night about Ireland's Great Hunger. The thought that kept running through my mind was, "How could people be so cruel as to evict people from their homes and let them starve with so much food available, but being exported to England?"
The answer is that food is a commodity. A commodity is a use value and and exchange value. The use value is the material properties that enable the commodity to satisfy human needs and wants. The exchange value is the commodity's quantitative worth or price. For commodity producers and capitalist commodity producers the most important aspect of the commodity is its exchange value. One important implication of this is that if one doesn't have the money to purchase the commodity, e.g., health care, then one doesn't receive it and, in the worst case, one dies.
Now, if you don't like this result, then you don't like capitalism. It's time to prioritize human life over insurance companies' and other capitalist corporations' profit.
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@stewarjt a beautifully crafted analogy, stunningly beautiful! Bravo! I would add that exchange value is FALSE value, which makes Wall St. worse than Las Vegas casinos. Use value is TRUE value.
Krugman, your NYT/Establishment talking points are tiresome.
What people love is their doctor/their healthcare providers, not their insurance company... but this can be so easily manipulated by pundits like Krugman to scare people into thinking they will lose their healthcare.
Krugman, may or may not be smart enough to know that Medicare for all, as one bargaining unit, will get considerably better prices for pharmaceuticals and medical devices, also "paperwork" would be considerably simplified, no need for profit and overpaid CEOs with four hundred million dollar golden parachutes, no hundreds of thousands of dollars spent on campaign contributions, no billions of dollars spent on lobbyists... medicare for all will definitely cost less than the current health care system which takes 17.8 percent of US GDP, and gets worse outcomes than the next highest spending country, Switzerland, using 12 percent of its GDP for healthcare.
Krugman and the NYT are not interested in facts, they simply are committed to protecting the status quo...
their status quo.
Thankfully, Senator Bernie Sanders has the facts, the ideas, the integrity and the courage to be forceful with the facts and stand for the people and medicare for all.
3
You are making the case for Biden and siding against Sanders because of your estimate of America's reaction to the wealthy paying more to cover the costs and your opinion on what would be the most palatable in terms of a shock to the system. I get that, but maybe America needs major shocks to the system to get any major result at all. That said, your major point that Democrats should quit arguing with each other with tactics and falsehoods that seek to diminish the "other" is spot on. This is the stuff of defeat and should be avoided at all costs. Moderate Democratic America wants Biden so bad they can taste it. Liberal Democrats want the shock-jocks, Sanders and Warren. Trump needs to be defeated. That is the common goal all who seek to lead this country, and they must come together for that purpose. On that we can all agree.
1
First, we need to educate the public about our existing Medicare system. Most younger people do not realize that it is not free-that recipients continue to pay. I pay $1608. a year for my basic Medicare that covers hospitalization. Private insurance companies provide coverage for prescriptions and office visits. People have choices and pay accordingly.
Expand Medicare gradually. Lower the age to 62 (which will allow workers to retire earlier, opening up jobs for younger people). Provide basic hospital care for all ages. Americans prize freedom-they should always have the choice to pay for private insurance and medical care but pay into Medicare through a tax that provides for the general benefit (like school, police, library funding).
2
When it comes to arguing about the best way to alchieve health care for all, the elephant in the room is always cost. Simply put, single payer would lower costs, since it allows government to negotiate prices with medical providers and Big Pharma. But if everyone is so scared of "socialized medicine," by all means let people keep their private insurance while offering a public option to those who don't have it or can't afford it. Like Medicare, now hugely popular despite the gipper's grim warnings, a public option will also lower the cost of private insurance by forcing it to compete with the government or end up on the sidelines as a supplement or a perk for the rich.
1
Totally agree: Dems should act in lockstep on this point.
I suggest the working title of Krugman's next book be, "Conscience of an establishment centrist."
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@Mark
Yes, -- but --- Mark the dominant, and enforced focus of crony capitalism over the entire scope of Paul Kennedy's "Rise and Fall of the Great Powers (qua Empires) 1500 -- 2000" has been nothing but 'labor cost displacement ' and 'negative externality cost' disguise for a Global Empire.
Whereas, the noble value of "Krugman's next book" could well be the sui generis of 'energy cost displacement' and 'positive externality profits' for a world of global democracy.
1
@Mark: Alternate title: What I did for want of a job at cabinet level.
Bernie is not I repeat BERNIE IS NOT A DEMOCRAT. Bernie does not care about the democratic party. If he did he would have pushed Hillary forward instead of poisoning the well and working to get Trump elected.
Bernie poisoned the court and will poison the democratic party.
Bernis is only about Bernie at eh end of the day.
1
@Andy: Bernie is a Democrat in the old sense of the word, from the days when Democrats represented the working class, which with the exception of Carter and Johnston hadn’t been the case since FDR, in fact Eisenhower was more of a Democrat than any of the DINOS of the last fifty years. With all due respect Andy, the rest of the world acknowledges that we no longer have a two party system in America, and the snarky comments along party lines validate that as well as allowing the charade to continue; we are still in the process of draining the swamp, Trump was a disaster in his signature legislative gift to the rich, but he’s not wrong with attempting to correct huge policy gaffs with China and our part in playing unpaid policeman to the world, unfortunately that has, like his other promises, has fallen far short of necessary measures.
5
Another nail in the coffin of Democratic hopes.
1
In a service based economy, to pay some professions 75-100 per day other make far less, 7-10. This is not working and understandable why the far less need healthcare.
My opinion is, both of these men can stop stringing the American people along and Mr. Biden's cancer research can continue without him as our head-in-chief.
The Romney/Obama Care Act is KEEPING (I am not yelling but I am emphasizing) many of us in major debt. It's a slave economy.
3
I have excellent health insurance, but I choose to get all my health care at the VA. Why? It's excellent. The care is superb, my care team actually knows me and cares about me, and they know the unique issues that veterans have. The VA is British style socialized medicine, and it works. I realize we can never have that here, because we can't have good things. I also realize that there are special interests that want to destroy the VA to suck the money out of the system. An open mind would consider some version of the British style National Health Service.
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As a septuagenarian I can say this - they act like couple of old goats in an assisted living facility arguing over a pinochle game.
Get over yourselves guys and get out of the way of Liz Warren!
The Trump Wall st Administration has been vacuuming up insider information for financial gain by placing industry leaders in managerial places.
@SHAKINSPEAR Nothing new there where do you think Bernanke and Geithner went as soon as they left office, the same place Paulson, Summers and the rest of their ilk are from Wall Street or a supporting role in ripping off Americans.
Face the truth: America will never have Medicare for all or any other version of single-payer health insurance. Why?
Because corporate medical and pharmaceuticals, and Republicans haven't finished picking the pockets of Americans who are so easily snookered, duped, bamboozled, hornswallowed and lied to, that they would actually vote for a vulgar conman, puppet of a murderous Russian oligarch.
2
Well, neither one is a democrat.
If this were a TV show or movie, it would described as Paul continues his shill for Warren, in Part XXXV of his continuing saga.
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@Ryan Paul is 100% for Biden, he’s still hoping for a cabinet level or above position, so he follows the dictates of the DNC.
Looks like Warren's window is opening wider...and wider.
1
They both should drop out of the race and become gracious advisors to the party nominee. This is not ageism on my part; I say this as an active septuagenarian who thinks we don’t need another old white male president!
Jeez, Krugman admits Biden using Republican scare tactics and misrepresenting, but castigates Sanders for speaking up too forcefully.
C'mon Paul. Be better.
For an awful vast majority of commentators spouting opinions without ever reading the M4A legislation;
https://www.sanders.senate.gov/download/medicare-for-all-act-of-2019?id=0DD31317-EF09-4349-A0D4-0510991EF748&download=1&inline=file
https://www.nytimes.com/2019/04/02/health/americans-health-care-debt-borrowing.html
https://feelthebern.org/bernie-sanders-on-healthcare/
As our current HC system stands, the status quo allows 30+ million to go without HC. Tens of millions are afraid to use or access HC 'cause of costs, thus putting millions at risk until sickened to the point of needing emergency care. The most expensive care that EVERYONE has to pay for. America avg. 45,000 deaths ea. yr. from lack of care. 600,000 people declare Med. Bankruptcy ea. yr.
Our For Profit system saw HC Insur. Corp. saw 29% increase in profits in the second quarter alone. $6 billion dollars for 3 months.
We are being scammed.
We empty our pockets to pay a middle man based upon scare tactics and propaganda. While beggaring and killing our fellow citizen.
Only in America.
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@Dobbys sock: Kudos!!!! Very well put!
2
Joe Biden is behaving badly. Bernie Sanders is behaving badly. Nancy Pelosi is behaving badly. The Squad is behaving badly. Kirsten Gillibrand has behaved badly, far worse for her Party and country than Al Franken behaved. (Sorry, I don't mean to offend by this but the truth will out.) The DNC isn't behaving at all and neither is Chuck Schumer.
When your opponent is committing suicide, it's bad form to shoot him or her for good measure. The only glimmer of good news is that the president and his army of trolls simply cannot control their collective expulsion of racist bile on a public that we hope is sick of it.
I wish both would drop out and leave the field to the fresher, more energizing candidates Warren, Castro, Harris, Booker, and Buttigieg.
Paul, you have been rabidly opposed to Bernie Sanders from the get go. Any reference to him, made by you, is not to be taken seriously. You proved to us beyond doubt, in 2015-16, that you cannot be unbiased to any word uttered by Bernie Sanders. So please spare us any pretense of being remotely objective.
5
To those advocate excluding any person from urgently needed or preventative medical care regardless of migration or citizenship status, do you want risk becoming ill from a serious communicable or contagious disease by eating in a restaurant from a back kitchen “Typhoid Mary?”
1
Sanders has gone totally bananas....
and Joe ? Totally mediocre....
2
Krugman's column epitomizes - yet again - the predicament: it is ideologically and politically unacceptable to factually challenge any Democrat who is not an old, straight, white guy.
Dear Krugman, just a few years ago you were mocking Bernie and his supporters..."Bernie Bros" Gee, funny how things can change on a whim in your mind.
As progressive Texan, Jim Hightower, has famously said for more than a decade about compromising or taking a 'middle of the road' position between democracy and Empire (on Medicare or anything else) "The only things in the middle of the road are; yellow stripes, dead armadillos, and JOE BIDEN."
3
Yeah, we get it: you've never liked Bernie and you don't like him now.
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Let’s just rebrand Medicare For All and call it a war against terrorism in Medforallistan. Maybe we’d find the funding and political will to back it then.
3
Elizabeth Warren has the way to pay for it: a 2% tax on every dollar over 50 million earned on the wealthiest Americans. That pays for healthcare and more.
Speaking of "bad faith," why is Krugman misconstruing Bernie's words and glossing over important facts? Specifically, Bernie said he wants to end corporate greed in the health care system with M4A, but he *did not* say that "only" M4A could do that -- it's just the solution he has chosen. Krugman then argues that the statement he falsely alleges Bernie made is "belied by the European experience," but neglects to mention that the private insurers offering core health coverage in the Netherlands and Switzerland do so not-for-profit. Nowhere in Biden's plan, nor in Krugman's hamfisted "both sides" false equivalency, is there any proposal to transform American health insurers into non-profits.
3
I agree that it would be better if the Dems stuck to substance, but is it surprising that the knives were sharpened following the attack on Biden by Harris? Sanders saw that vitriol worked, and Biden saw the necessity for returning fire.
Speaking of "bad faith," why is Krugman misconstruing Bernie's words and glossing over important facts? Specifically, Bernie said he wants to end corporate greed in the health care system with M4A, but he *did not* say that "only" M4A could do that -- it's just the solution he has chosen. Krugman then argues that the statement he falsely alleges Bernie made is "belied by the European experience," but neglects to mention that the private insurers offering core health coverage in the Netherlands and Switzerland do so not-for-profit. Nowhere in Biden's plan, nor in Krugman's hamfisted "both sides" false equivalency, is there any proposal to transform American health insurers into non-profits.
1
I still fail to see why Medicare for All eliminates all private insurance - Medicare currently has 2 parts - A and B and you have to pay extra for part B (based on income) and then most seniors have supplemental coverage which is private. And all the prescription coverage is also private. So is dental. So if you take the current medicare system and add people to it you still have private insurance- it will be vastly reduced but still there if you want it and can pay for it.
Not to mention costs of health care need to be addressed: The 30$ ibuprofen, the blood test that is 350$ if you don't have insurance but 35$ if you do, the MRI that costs 200$ in some places and 1800$ in other with in the same geographical location. The actual cost needs to be figured out so a reasonable price can be set.
The strong shift of Sanders to the left, the belligerent attitude of the 'squad', the anti-Israel stand of Omar, all point to the inevitable defeat of Democrats in 2020, unless they learn to unite under the leadership of savvy Pelosi.
I see no alternative between the choice of government health care along with the availability of private insurance.The ultimate goal should be to bring heath care costs down.
I remember in the early days of A.C.A. the Republican opposition to it incessantly threatened that if we passed this program, before long it would evolve into a totally government funded (single payer) system. So why not? It's inevitable. Over time. So why not strengthen and improve A.C.A. and if it becomes a single payer system so be it? But it will happen because citizens and companies will learn to appreciate it. Senator Sanders and his cohort clearly don't want to give Americans that time, to adapt to the changes and in the true spirit of a democratic republic, have input into how it affects us all. Instead of running on their respective boutique platforms, they should all be fighting for Universal Coverage and let the citizens choose the right path once in office. Companies will like it too.
BTW, I worked with a European company that had just begun manufacturing automobiles in the US. several years ago. Managers were stunned to learn that employee's health care had to be factored into the wholesale price of each car produced, instead of being "picked up" by the government and covered in corporate taxes, as it was in their home country.
When I talk with friends who have retired in the US many talk about the fear of a health crisis ending their current lifestyle due to the crippling cost, and they believe this will happen just a question of when.
This is not the case in Canada.
2
Mr Krugman somehow believes that corporate greed will not be an issue with the Biden plan. Our legislative processes are not only paid for by the corporations but the oversight regulations are more often than not penned by the very corporations the legislation is intended to reign in. Then, assuming even weak legislation is passed the corporations will chip away at what protections against greed those regulations contain. We’ve seen it time and time again.
The only way to protect ourselves against the “profits over people” mentality of our America health care business model is to remove health care from corporate control.
Health care is a right not a privilege. Sanders is correct. Single layer is the only way we can protect ourselves from the corporate greed that has destroyed Americans’ access to affordable health care a la Medicare or the single payer Euro/Canadian systems.
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@Michael Levin
How is health care a right?
The Swiss system could never work in the US because, unlike Switzerland, the US has very high poverty rates.
1
Then there are all those retired Federal employees. A woman who used to teach retirement seminars said about 2012 that she used to advise employees either to take Medicare part B or carry the federal insurance, usually Blue Cross Blue Shield, into retirement to cover gaps. By the end of the first decade of the 21st century she was advising folks to do both. I did and annoying as it is to pay for both it does seem to eliminate most if not all medical bills. It covered the cost of my cataract operation.
So whatever these gents are arguing, follow the retirement planning lady, choose both.
Can an economist explain why we pay more than other countries but somehow we are always told we will pay more? But we are the one country which doesn’t have social health system and actually pay more with less people covered.
Small businesses need to jump on this. And big business might also benefit as this might reign in costs by health care they keep pushing back on the workers when they get a raise that eats it.
1
your op-ed piece points out just one reason we do not support either biden or sanders: ie., they are "old-school" pols. cranky. voters don't want to hear it.
instead, let's start listening to candidates a little further down the "popularity"/polling lists, like amy klobuchar and cory booker (who, we think, would make a great ticket).
It is truly unfortunate, that Prof. Krugman, the economist, prefers to take back seat to Mr. Krugman, political commentator. Two key reality questions that are in need of answers, and which Prof. Krugman avoids providing answers although key to the understanding the controversy. involve measures of costs and benefits.
(1) What is the NET cost of providing for a single payer health care system? Taxes are sure to rise, but premiums are certain to fall. Included in this measure must be an estimate of the overall reduction in total health care costs as the US far exceeds all other First World Countries in the share of GDP accruing to health care even if health outcomes are not better.
(2) Who bears the costs and benefits of a single payer system? Overall such a system will benefit the relatively poor and those with chronic health issues. Specifically, the well-to-do, can expect that they will lose their "Cadillac" plans and have to accept the coverage available to all.
The health care industry, including medical practitioners, will find that their current revenues will fall as the overall system reduces waste, although "conservatives" claim they love EFFICIENCY. Moreover, medical services would be allocated on a triage - needs - basis instead of the current one based on ability to pay. This would improve the EFFECTIVENESS of the system as e.g, vanity services, would be lower on the treatment scale. It also would be a more EQUITABLE system.
Oh, it's POLITICAL economy.
1
And without healthcare rationing, a thing Americans have not had to deal with, the annual taxes will become astonomical on a yearly basis.
Imagine the 85 y/o who will be denied their hip replacement etc., due to cost considerations.
It will be a tough bite of the apple but will need to be done.
1
Well even Paul K gets it wrong, something on the order or 80% of those with current government health care, Medicare and so on, have some form of supplemental coverage they purchase or have as a result of other government benefits — i.e. federal retirees.
Wholesale elimination of private insurance, a la Sanders, is clearly a leap too far for America still so profoundly politically divided. As the centerpiece of a Democratic healthcare reform this will surely derail the most important effort of all — ensuring that Trump does not have a second term as President.
1
If I heard the argument that a single payer plan: A. would be about as good coverage as I currently have through an employer; B. The tax increase would not exceed what I'd save on premiums and co-pays; and C: I could never lose it despite employment status and pre-existing conditions, I certainly won't shed tears over giving up the employer's plan. I don't get to choose which plan I have or what it covers, or what physicians I can see. And I am painfully reminded that my health care is managed, not to optimize my health, but to limit costs for the employer and to maintain profit for providers. If the debate can get beyond "taking away your insurance," I think people could be persuaded that single-payer would be better than what they have now.
5
@Mark Totally agree. Although an expat for 20+ years, my twice/year visits to the USA demonstrate to me that the country has more "I've got mine, too bad for you" types that couldn't be bothered to spend the intellectual effort needed to do your analysis...but would have no qualm over setting up a go-fund me page when serious illness hits them.
1
Biden should just say, "my plan is in line with those in Switzerland and the Netherland (and whomever else in Western Europe is using this kind of plan), but set out the differences. That way, he can also cite examples of how it works there. Many of my friends who have lived there and then moved here find our system crazy compared to theirs, which they say is simpler, more rational, more affordable, and does a better job of cutting things out like unnecessary meds and procedures.
I suppose he'd need to be prepared to cut off Republican reactionary (but successful) assertions that he must be a "socialist" to propose a system that looks anything like what Western Europe does.
1
My wife, who is 60, has cancer. She likes her job and wants to continue working as long as she is able, but she worries about being without her work health insurance. Why? Because the Affordable Care Act is so uneven, costs of care are so unpredictable, and even Medicare leaves some people in medical bankruptcy. Why should she have to worry about these things when fair, low-cost and low-overhead methods of paying for health care are available in every other advanced economy in the world? Why do I have to worry about the outrageously high costs of hearing aids, eye care, and dental care as I age after a lifetime of hard work and community service? Bernie's arguments and his health care proposals make the most sense and focus our health care investments on actually providing the services that are necessary rather than lining the pockets of insurance executives. That's what government should focus on.
7
On Twitter, Bernie is lumping Biden in with the Republicans, and that should be a no-no for a Democrat. Disunity among the Democrats is probably the only thing that can re-elect Trump, and both parties seem to be trying to achieve that end.
2
Will left leaning Democrats age 65 and older approve of the Sanders Medicare for all plan when they learn their taxes go up to subsidize the under 65 group?
4
For either plan to really work the simple question is this: are we ready to take on the phrama/insurance industrial complex? Obama looked at it and backed away for good reasons. Other countries have a system indirectly subsidized by our system which overpays for drugs that they get access to. Even the media which makes a fortune from the advertising that these industries spend on has a share of gain from the system. How can this succeed if that is not a core part of the plank which is acknowledged?
5
Good point. We are ready if we elect more squad members who actually care and want to end the corruption.
1
The price of a place on the debate stage should be the candidate’s DRAFT national budget. Who makes how much. How much of it do we tax? How is it spent? What is the socially responsible liberal media’s reason for not establishing such a requirement?
1
The problem with many of your comments Paul is you seemingly have little “ real world” experience and deal in Ivory Tower hypotheticals. First, your insistence that small steps towards single payer will work has already been disproven by the poor record of the ACA. Yes there are more people insured but at the cost of others, in particular those on Medicare even with a supplement. The insurance companies made zero concessions in fact there stock prices went straight up since the inception of The ACA and the quality of Medicare coverage went straight down. There was a simple explanation for this, insurance companies pay Doctors less for those on Medicare so the dirty little not so secret is Doctors don’t want Medicare patients as long as they have a “Doctors Option”. Bernie is right as long as there is significant private insurance single payer won’t work, the Doctors unfortunately are a big part of the problem. In rural Oregon where I now live I have tried for four years to get a G.P. with no success. The simple reason is( rain aside) Doctors don’t want to serve communities with large segments of the populace on Medicare and the rest on Medicaid. We rely on, drop in clinics with N.P.s and Doctors signing one or two year contracts, when they’re up it’s bye bye. Biden is the 2020 version of Clinton, a flawed candidate in the pocket of big donors. Dr. K proposes our plan emulate that of Switzerland and the Netherlands, small, wealthy nations with no military burden, good luck.
10
Bernie--Health Care for ALL.
Biden--Health Care for 97%, so 125,000 will have none.
The correct choice is an easy one.
3
Sanders's criticism of Biden is completely valid. In a policy battle, Bernie will win out. Corporate greed in this country is holding us back and it shows each and every year as Americans go without insurance and go bankrupt over medical bills.
7
@Frank I couldn’t agree more Frank, Biden is a repackaged version of Clinton, a choice of the status quo DNC who hasn’t represented the Middle Class for decades. Bernie/ Warren or Warren/ Bernie is the only ticket that will beat Trump, several other candidates have many positive attributes but are much too “niche specific “. Nominating Biden, although I have to admit he looks great, his dental work, facelift and Botox are exceptional, will insure four more years of Trump, you can’t fake your way through a conversation or a debate with cosmetic enhancements alone. Biden isn’t just Republican Lite, his position on the bankruptcy laws he helped usher through put him in the category of Joe Lieberman and his vote against the public option, he’s a menace to the Middle and working class.
Krugman should stay in his own lane, on some remote country lane. Medicare has no capacity to control the single biggest cost: prescription drugs and medical appliances, which Senator Sander's MFA would do. The ACA expanded medicaid and is a step toward a Single Payer structure, but a long ways from it. Criticizing Senator Sanders is a low bar even for Krugman. Shame on you! Go Bernie and Elizabeth!
4
That we tolerate a healthcare system that fails to serve the needs of people with the glaring deficiency and consistency of our current one is disgraceful and inexcusable .
To refer to the notion of a Single Payer MedicareForAll system as purity isn’t an indictment of Bernie Sanders or the millions of activists who support it -it’s an indictment of our liberal and conservative mainstream punditry who tell us the abnormal is normal and the perverse is acceptable.
It’s also an indictment of Capitalism run amok with the predictable condition that Capital equals power and therefore controls government and the representatives responsible for stewardship of the commonweal .
Bernie isn’t a purist . He’s the rare representative speaking truth and fighting for the security and justice of We The People .
Our priorities and values have become so warped and corrupted that we see the truth Speaker as a dangerous aberration that must be shunned , maligned and ridiculed .
Shame on us and shame on you Dr Krugman.
3
Why do we always hear about making health insurance affordable but almost never hear about making medical treatment and drugs affordable? Government contractors have nothing on hospitals and doctors when it comes to fleecing their customers. Think I'm kidding? The next time you receive medical treatment at a hospital request a detailed bill. I think you'll be surprised at what you're charged for.
2
I accidentally received a bill about 20 years ago when I went to the emergency room for pain. I had a kidney stone. They gave me a morphing drip, x-ray and I was maybe there 3 hours. I had also been driven there by family. The total cost was over $10,000. The hospital was trying to gouge the my out of network insurance. I had no say in the bill and my insurance never questioned what service I received or didn’t receive.
There is no way this profit is going to staff alone who perform the work.
Since when was a winning presidential campaign based on detailed policy proposals? Keep it very simple Dems .... just tell the American people three things:
1. Your plan won't take away coverage
2. Your plan will expand coverage
3. Your plan will bring down prices.
The rule of three!
Does anyone seriously think that Trump has the wherewithal to offer up a plan that amounts to anything other than - "It's gonna be great?"
2
I have a very conservative friend who is all against national healthcare. Fortunately for him, he is a veteran and gets free healthcare for life from the government-run VA.
Hummm.
1
Nahh, only one of these people is behaving badly, and it's Biden.
We really don't care about 'the party's chances'. The Democratic party was destroyed by Bill Clinton, and what remains is not worth major concern. Better parties will emerge.
We've seen the loser ideas of the Democratic establishment. I don't doubt they think the US can be like Switzerland with it's shadowy banking system and all! We can all be rich bankers with wonderful private health care, because of course we don't need anything but banking! It's all in the finance!
This is a loser party. Warren/Sanders is the only possible future for it.
3
Thank you, Paul!
The circular firing squad has to stop and Dem candidates must speak truth to power!
We have had enough of lies and deception.
Please, please, Dem's, just state the facts and tell people why you think your idea is the better one.
The facts will speak for themselves.
1
What good is having health insurance in the US when you can still wind up with hundreds of thousands of dollars of debt?!
4
You start this piece out talking about universal coverage... then no mention of how Biden's plan is explicitly not universal? Leaves 3% uninsured by his own team's estimates, which is better than now of course but would still result in 12,500 preventable deaths/year (https://www.peoplespolicyproject.org/2019/07/15/bidencare-system-will-kill-125000-through-uninsurance/).
1
Having insurance doesn’t mean you can afford the bills they send.
@Mathias You don't have to tell me, my deductible is 3x more than I have in savings. Another reason why Bernie's plan is better!
The Democrats need to explain how their plans work and explain why The Republican plans do NOT. Do it like Ross Perot in simple stark terms using charts. You have to call out the lies; most Americans are largely uninformed and only catch sound bites.
What we really need is for Sanders to get out of the race. He's still the same ranting old man he was in 2016 when he and his minions undermined HRC instead of graciously ending his "campaign" when he lost the primaries and backing her in word and deed and instead did nothing to stop his voters from either not voting, tossing their vote in the trash by voting for Stein, or worse -- voting for the orange monster.
Sanders' proposal is a loser with most of the public. Improving Obamacare is the way to go and no sane person wants to go back to a system that allows insurers to refuse people based on "pre-existing conditions." I literally had coverage for my right knee removed from my Blue Cross of FL policy because I'd had an MRI years before that showed a slight miniscus tear. It's 22 years later and my knee is still perfectly fine but back then BC wouldn't "insure" it because it was a "pre-existing condition."
2
Medicare is not a single payer program and for Sanders to tout it as such is truthiness. Medicare straight from the government requires co-pays and deductibles for which we need private insurance companies for coverage help. Those who can afford high monthly private insurance supplemental insurance to cover co-pays and deductibles can choose their health care providers and need to pay for separate D prescription drug plan . Those who turn to private insurance Medicare C with D prescription coverage advantage plans have limited networks and delayed care.
All Medicare private insurance plans whether supplemental or C Advantage operate under a plethora of regulations that work for the private insurance companies and against the individual and Sanders has done nothing about the problems we have faced. . For example, a Medicare Advantage plan can drop a group of healthcare providers whenever they choose to, as United Health Care dropped Yale providers in the Southern Connecticut area. Under the current rules those in the plan could not switch to another Advantage plan until the limited time enrollment period in the fall. To see their Yale health care providers--who comprise a majority of providers in the area--they had to switch to straight Medicare with no help for co-pays and deductibles.
3
These two men can debate this in detail all they want to gain the necessary attention they both seek, however the reality of the health care debate is that if the Democrats do not come up with a true system which allows Americans a real choice in how their healthcare coverage is provided, it will all be for not.
The ACA was the start of "choice". but writ small. A truly American form of health care for all would include: Medicare for all who choose it; Employer sponsored care who can afford their employer's plan; Individual coverage; and finally, no coverage, until a person demonstrates they cannot pay for the care they receive without coverage. At that point, they would be placed on Medicare. This plan would also establish a government agency which would establish price limits on all medications, which for a fee, health insurance companies could access to lower their overall coverage costs.
A seamless care system which satisfies the vast majority of our citizen's needs, and ideological beliefs, is the only way one can imagine a truly new way to bring the cost of health care down for all citizens.
The fixing of either model as definitive misses the greater good of a simple appeal--Dems are for universal, high quality, affordable healthcare. Advancing an explicit model is premature given the complexity of deep structural change. What happens when these proposals are wielded by the press is an irresponsible flattening of substance and impact. This gifts the GOP with their favorite fear mongering claims--death panels, socialist care, loss of insurance as you know it. You cannot reduce proposals to talking points on health care.
Run on universal, comprehensive quality care. Grant that writing that policy and implementation protocol is hard work, but Dems will commit to it, unlike the GOP.
In the Netherlands the private insurers are mostly non-profits that have their origin in a previous incarnation of the system were the government played a bigger role.
In the US the private insurers have a much more rapacious reputation. It would take major legislation - including restrictions on the freedom of the insurance companies to set their own rules - to tame them.
The Obamacare legislation contained lots of concessions to companies. The article paints that just as concessions to the Republicans. I strongly suspect that corporate-friendly (pardon: moderate) Democrats like Biden were quite happy with them.
My feeling is that Sanders' approach would be the easiest to achieve. The Biden approach will create a very broad front on which there will be trench warfare with companies.
I don't believe Sanders and Biden are behaving badly by having this discussion now. When I see the superficial way in which Krugman discusses foreign systems I fear major trouble later on. The reason Obamacare became such a mess was exactly because this kind of discussion hadn't been had before.
3
Please can we call it The Affordable Care Act or ACA? The sooner we take away Obama's name from this the sooner the country will accept the program.
I support Pete Buttigieg's plan, which is to put a "Medicare-for-All" type option on the exchange and let anyone buy into it. This will be a way to transition to full Medicare for All without upending everything at once.
2
Has anyone surveyed Corporate America about not having to provide healthcare for its employees?
If you have Medicare for all, why would that eliminate private insurance? All insurance seems to be enhanced by other coverage. Just like Medicare works now.
Finally what do hospitals and doctors think about a single payer plan? Do they support a single payer system.
The present system is costly and it does not offer the user any security. The cost can change from one bill to the next and the coverage can change at the whim of the insurer. Where are those public servants who are above the political fray and have all the answers?
1
Taxes go up to pay for universal healthcare but, if we continue with graduated rates then the rich pay more so the less well off can get a break that makes healthcare affordable. Seems a good way to help balance out the inequity in our national wealth while reducing overall costs.
Then you have the idea that hospitals will go bankrupt with the lower reimbursement rates of medicare. Who really believes that this is a problem that we will allow to happen. One of the principals of the ACA was to save rural hospitals.
WE all need to take a deep breath and not get caught up in the overheated rhetoric as we attempt to create a system that can work for all to replace the current system that is by all accounts a broken one.
I don't quite get how everyone seems to be ignoring the existence of Medicare Part D Advantage Plans. A majority of the people I know (including me) on Medicare are on Advantage Plans. I'm on a Humana PPO that has so far worked well. If Medicare keeps these, Medicare as a single payer would still have the private healthcare insurers involved. Does Bernie plan on getting rid of Part D? If not, a lot of this argument seems moot.
Dr. Krugman:
You're an economist, why don't you give us the numbers? If everyone went on Medicare, how much would the premiums be, by age? How much would the government have to subsidize healthcare? How much would taxes rise? And above all, how would that compare with how much people pay now for insurance? Why is no one giving us the numbers?
1
Paul tells us. “But it’s not a fair criticism of a health plan that’s actually pretty good, and which most people would have considered radical just a few years ago.”
This is what I hear from the working class:
(1) I cannot keep up with ever increasing premiums and co-pays.
(2) The subsidies are not enough.
(3) My spouse does not bother to fill his/her prescription – we cannot afford it.
(4) I take a half dose - it lasts longer.
(5) I skip doses - it lasts longer.
(6) We borrowed money from family for [insert name] last hospital stay.
(7) [insert name] ended up in the hospital. [insert name] knew he/she was sick but could not afford the doctor visit.
The deficiencies in the ACA are growing and those with less earnings and less wealth are foregoing doctor visits, hospital stays, medications, and procedures, often making matters worse.
Sanders wants to start over. Biden wants to work within the current system. My fear is that Democrats will alienate either those with “good” healthcare or those without healthcare in part or whole and that Republicans will lie about providing better healthcare without change and sacrifice for all so as to exploit the divide for another win.
Both Sanders and Biden require change and sacrifice. As a nation, we fear change and we have forgotten how to sacrifice to help others. And Republicans will exploit our collective selfishness every time.
1
It is sad that the "debate" over medical insurance is not being used to educate Americans. Medicare, despite popular belief, is neither free, nor does it cover 100% of the cost.
Medicare does provide hospitalization (Part A) at no premium cost for those who paid into the system over the required period and it does charge a premium for those who did not pay into the system. Doctor visits (Part B) has a monthly premium, as does Part D (Prescription Drugs) and none of these programs covers 100% of the charges. Medicare Advantage might cover everything but those plans are provided through for-profit insurance companies so their rules are flexible and always changing.
Still, most Americans hear Medicare and think "FREE."
Could the government open medicare to those under 65? Yes, but there will be monthly premiums and a need for supplemental insurance if you want to be assured that 100% of the bill is paid by insurance. Unfortunately, nobody talks about that. (Actually, opening up Medicare to those under 65 might, given the additional premium dollars, make Medicare healthier.)
Of course, what nobody questions is: How do you get these ideas translated into law? Nobody wants to talk about that either.
While the candidates trade barbs, most Americans still think that Medicare is free, covers 100% of all medical costs, and are in for a rude awakening.
1
I enjoy the perspective of someone who has resided in the US and Canada for many years.
Premiums under the Affordable Care Act still seem prohibitively expensive for too many, and Biden’s proposed amendments would only add to its complexity and administrative costs. Employer-paid insurance is also hugely expensive.
Public sector employees—educators, for example—who typically enjoy the best coverage, have seen their share of monthly premiums rise, but they are still shielded from the actual cost to the employer. Whether this cost is ultimately subtracted from employees’ hypothetical compensation is not clear.
A universal healthcare plan would distribute the cost over the population—more equitably and proportionally to those who can most afford to pay. Sanders himself has acknowledged that middle class taxes would go up to sustain such a plan.
A universal healthcare plan would also eliminate the exorbitant fees, administrative costs, and executive compensation associated with private insurers. Just check the stock performance of companies like Anthem and UnitedHealth Group.
An existing government department such as Health and Human Services can be adapted to administer a universal healthcare plan economically and efficiently.
4
We have plenty of smart practical people (eg, Krugman) who could devise an excellent universal healthcare system. What we lack is the will to do it. That's because we can't do anything for its ostensible purpose. Instead, every economic activity, whether public or private, is just another opportunity for wealth extraction. Take the pharmaceutical industry that pushed opioids to turn people into addicts. Or the Pentagon/defense contractor nexus that builds defect-ridden aircraft that will never fire a shot in anger or enormously expensive aircraft carriers that are sitting ducks.
We need to restore public trust that our institutions, public and private, are devoted to their intended missions rather than a charade for enriching themselves.
Then we can tackle healthcare.
1
I don't see evidence here of the false equivalence of bad behavior the Krugman's headline imputes to both Sanders and Biden. "Corporate Greed" would be eliminated by eliminating private insurance from the medical care pie. Biden has a long history as a defender of corporations as Krugman briefly mentions. The video on Youtube of Elizabeth Warren taking him on over his making person bankruptcy harder is well worth watching. He was the Senator for MBNA the credit card company and is running a good old Joe campaign.
After Trump we're going to need a reboot. Incrementalism is the same-old, same-old crumbs from the table and people are tired of it. The Dems better run someone who inspires, whose gonna make people want to vote, not just hold their nose and vote.
Let's face it: Biden is Hillary Clinton Redux and it won't fly. Trump can't be defeated by a "hold your nose and vote" campaign. Didn't work in 2016. Won't work in 2020. Insanity is making the same mistake and hoping for a different result: Einstein.
5
I wish that Biden and Sanders had not run and were not dominating this campaign so that younger candidates could have their voices heard and the most charismatic could rise to the top.
4
A thoughtful article which ( like all the articles I have read ) ignores an important fact: the high cost of medical care in the USA compared with other comparable countries , In the USA the yearly cost of medical care is $ 10.000 per capita ; in Western Europe it is about 5-6.000 dollars The extra cost does not get Americans better health ( although it does get them more conveniences such as less waiting time, choice of doctors, etc) . The reasons for the difference are many ( such as the higher wages of doctors, nurses, administrators , the defensive medicine which means many more tests, etc.) and probably intractable politically.
Another consideration ( which is only in part considered by the writer) : how do the Europeans pay for their systems.
In Europe there is a value added tax of 22-25% on all consumers goods ( except food ); the tax on gasoline is 70% ( in the States it is about 13% ) . Ask a New Yorker ( rich or poor ) if he would pay a sales tax of 32% ( the existing sales tax + the value added tax ) on his purchases, and $6 dollars a gallon for his gasoline. He may vote for a conservative candidate
3
We sent people to the moon and brought them back alive and where having problems solving this healthcare for all issue, even when the hard work has already been done by other countries and by the way Medicare and Obamacare. how low can the bar be.
Medicare for All is the most highly thought of proposal on the progressive agenda. It has been Senator Sanders signature issue for decades. And this right wing Democrat has the nerve to suggest that WE - not Sanders - but WE give up the policy most wanted by US so that the insurance companies can have the candidate they want?
70% of the people in the country want Medicare for All.
Krugman, you live in a bubble of wealth and privilege and it is your ilk that will give us 4 more years of Trump.
We saw what happened the last time the DNC ignored what people were saying, shouting, yelling what they want and need: single payer health insurance that pays not one thin dime to the health insurance companies.
9
It is probably too much to ask politicians who aspire to higher office to give up infighting. It can clarify issues and better determine public response to them. Political warfare is often nasty but usually short lived. Given the incredible length of this Presidential campaign it allows for plenty of time to heal bruised feelings. So let the arguments flare but allow plenty of time for togetherness.
Current candidates with little support should follow Eric Swalwell's lead and drop out soon. Let the four or five realistic candidates fight it out and then unite behind the biggest goal of all, defeating Trump. Given the short memory of the American Electorate, they will forget about all those nasty policy disputes and focus on whether the most ill-prepared, ill-informed and ill-tempered person to ever hold the highest office in the land should get another swing at demeaning the Presidency and the reputation of the United States of America.
People vote their pocketbooks. Universal healthcare sounds good. The question is who gets to pay for it. Roughly 50% of the US actually pays Federal Income Tax. If you are one of the 50% who pays income tax and you get employer provided health insurance, you will bear the majority of the cost.
IMO the issue isn't Biden or Sanders behaving badly, it's Krugman behaving badly. I'm sure sure he knows better. For example, Krugman writes that a system of private insurances can be made to work because some European governments have shown it can be made to work. Oh yes, just as they've shown us how gun violence can be curbed, and how to curb the high price of drugs. Krugman does not acknowledge the uniquely flawed system of government we have where industries routinely buy their regulators and even the entire Congress. European experience with regulation simply does not translate well to the United States. If we rely on private insurance we can be sure that industry will be gaming its regulator. and even the entire Congress, to find ways to make more money at the expense of the insured - it's a big part of how we got the the present mess.
6
The most important problem with this article is that it ignores the supply side. People have good cause to be concerned about what will happen to the timeliness and accessibility of care under either solution. Neither Canada nor Britain perform very well on this criterion, even though both assure that medical emergencies get competent priority treatment without bankrupting the patients. There's a whole lot to say about how timely quality care will be provided under any of these approaches, and that discussion needs to happen in order to move any of these progressive proposals beyond the pie-in-the-sky where they unfortunately now sit on many people's minds. These options are of course doable, but the caveats and the missing detail is critical.
1
"Medicare for All" preserves a role for Heath Insurance Companies while providing basic care as a right. You must come up with 25 percent of your Hospital costs and pay for most drugs under Medicare. Many Medicare retirees buy supplemental coverage from Health Insurance Companies to protect themselves against serious illnesses that would leave them bankrupt. The general population will likely do the same under "Medicare for All", so insurance companies will stay in business, though their scope and the size of their profits will be smaller. Let's not set up a false dichotomy between our current system and "Medicaid for All"; there is a step in between that will improve on ACA. Let's not give independent voters reason to believe that the Republican Media and our President are telling the truth about a Democratic threat to their lives and incomes.
1
When people like Krugman write about European countries that have private insurance, they neglect to mention the most important fact. Those countries made medical insurance nonprofits. They are NOT for-profit private insurance companies like ours. (Though they can offer supplemental policies for private hospital rooms, cosmetic surgery, travel, etc., separately). Their employee-based policies have to be nonprofit, and identical to the public option. The minute people lose their jobs, they go onto the public plan, and have the same benefits. The genius of this system is not on the demand side, it's on the supply side. When a whole country has the same coverage, eliminating the profits that go to insurance companies, they are in a better position to negotiate better costs. They don't pay anything like what we pay here for prescriptions, medical procedures, or hospital stays, because they can negotiate lower profits for suppliers. The supposed huge costs of universal plans cannot be calculated by looking at what we pay now. Those inflated prices would be eliminated, as they have been in all those European counties that have better care than we have, at far lower costs.
5
@JA That is not true. Germanys private insurances are not non-profit.
1
@Mark B
Germany’s system is not analogous to ours. Most hospitals are nonprofits, and everyone gets basically the same plan, whether public or private. The government is very involved in setting prices for all.
What concerns me is the outrageously high and inflated bills sent by hospitals, doctors and other health care providers. There is no uniformity of charges among different hospitals and doctors. Still worse, unlike any other profession, the consumer is not told what the charges would be. There has to be transparency and uniformity of charges, which have to be reasonable, and not predatory. Hospitals have become big businesses, and yet they benefit by claiming a non profit tax status . These are the problems the politicians should be addressing.
5
A big and essential problem with ACA, aside, of course, from its failure to cover everyone; is it works as a tax dollar delivery system to insurance corporations. The nominal individual subsidy in effect just makes people the excuse for the sending of tax dollars to corporations. One suspects insurance firms have actually had a bump in profit as a result (or maybe it offset the ability to reject previous condition customers).
The majority of those with "private insurance" do not have their own, but their employers. But, suddenly without employer- no insurance. Happens a lot. But a further little secret is employers do not give health insurance as charity, they pass the cost along in pricing. Meaning anyone buying their product or service is paying a "hidden health tax" to give other folk care which said any one does not have him/her-self.
Bad deal. Still a version of that hidden tax will have to be assessed in any Medicare for all plan, the loss of employer "contributions" would make tax hikes odious.
The big sweetener in the Sander's plan is it gives Geezers (I get to use the G word, I'm one) teeth and eyes. In doing so it would stop the stealth privatization, as folks sign over their Medicare to private companies for added teeth and eyes benes , prepping for a direct corporate take-over in time. The GOP plan...
Pandering to geezerdom is a good play, given they (we) are a large tranche which votes in the highest proportion. It actually could cost Trump votes.
1
I know it seems silly to think of taking into account the opinions of people who actually do the work of caring for people's health, because of course, economists now know everything, but has anyone thought to ask doctors-or nurses how the system works or ought to. I'm just an old country psychiatrist (and a medicare patient) but from younger people's blogs the picture is dire.
Ask why there's so much burnout, so much depression among medical personnel. It's because corporatized medical care which is run by the insurance companies that Biden et al ,venerate, endorsed by Dr. K., have commodified medicine and taken the autonomy which is the heart and soul of practice.
Obamacare and its electronic medical records are killing medicine. I'd gladly have taken a pay cut of 25% not to have had my practice dictated down to the particulars by insurance companies and their goal of ;providing less service for their management's greater profit.
I'm not a big math guy but I figure medicare for all with administrative costs of 3-6% is cheaper than private insurance with profit margins of 18%. Tell me why I'm wrong Dr. K!
1
Nothing matters anymore. Trump, with the help of the squad and the booming economy, already has ensured his reelection. The demos candidates are absolite and their attempts to pull the USA to far-left to be continued in their next debate will just increase trump's victory. The best the Demos can do is Shut up the Squad and wait for another five years to try to win the next next election, which I doubt t they will do
1
Medicare for all, or single payer health care, is absurd if for the one reason fees paid to doctors would be 40% less than they are now. Given that, what young man would go to medical school knowing his pay day would be far less and, certainly, insufficient to repay his loans as quickly as before?
Meanwhile, pointing out the Canadian system as superior to ours is misinformation. My Canadian friends and business associates complain about the many month-long delays in getting operations as well as the mediocrity of the services. They are forced to get and pay for private medical service, a supplemental cost to the already high tax they already pay for the government plan.
180 million Americans have medical insurance. They don't want to lose it. The Democrats are blowing into the wind if they think their radical plans will play well with them next November.
1
Telling 180 million people, about half the country, that they must give up their private health insurance is an election loser.
Most people do not like change, and they certainly would not like to change to a big unknown.
Create a single payer public option, which people can understand, that is demonstrably better than private health insurance. If you build it, they will come - perhaps slowly at first, but they will come.
People who retire are usually concerned about losing their private health insurance and going on Medicare. Yet after experiencing Medicare, they are very happy with it. People adapt to change, but they rarely embrace the idea of it.
Healthcare is complicated because of Econ 101. Unlimited desires v. limited fulfillments. On top of that, a lot of people, not just greedy CEOs and corporations, rely on the healthcare industry for their livelihood. The extreme progressive wing has succumbed to the rhetoric that all financial folks are bad people. The same with healthcare.
Therefore, people who propose a single all-you-can-eat-buffet healthcare plan is either a simpleton or too partisan to run this country
Health care in most of the industrialized world is seen as a responsibility of government. The government's responsibilities are more than creating sets of rules and regulations but rather seeing to it that no citizen finds it unaffordable to obtain health care.
Our system in america long ago recognized its responsibility to our seniors to not have them bankrupted by a fractured hip or heart attack. We recognized that veterans were owed health care , and the very poor but there has been a blind spot. In a country where 50% of the population does not have 500$ in the bank , an arm fracture can spell bankruptcy in an emergency room. Yes some of those people have actually purchased insurance only to discover that the insurance will not cover the emergency room visit , or the deductible is not payable and can be sued for payment by that same emergency room.
American health care needs reform and it can not expect that new market solutions will suddenly appear. The very problem we are having is due to depending on market driven forces , driven by profits, to deliver health care to all, and this is not happening. So it will be up to government to deign a system that does not bankrupt individuals when in need of health care , and yes , as they say, there is no free lunch, so it is reasonable to admit there will be costs, but without that admission we will not move forward to join the rest of the civilized world .
1
Both Joe and Bernie need to sit down. They had their chance and neither won. Their ideas and expectations are not up to the current situation.
2
It's disappointing to see Democratic candidates squabbling, but at least they are presenting options and putting some thought into policies to actually provide some help for American families and American workers. Republicans, led by Trump, are doing nothing. Democrats may argue, but they are arguing over how to best help people get the health care they need. Republicans offer nothing in terms of health care. Literally, nothing. They have no plan and no policy, except to repeal the ACA and leave millions with no coverage at all. So, I'm disappointed that Bernie and Joe are at each other, and I agree they should leave personalities out of it, but I'm grateful they've put some thought into their proposals and understand the importance of this issue to average Americans. Trump and Republicans don't have a clue.
Sanders plan requires a wholesale revolution of current medical care, highly unrealistic as well as dishonest in its claims that private healthcare would be eliminated. The only Medicare recipients who lack supplemental (read private) insurance for 20% of their coverage are those who cannot afford it--hardly an enviable position. He dishonestly leaves mention of these supplemental plans out of what he thus misleadingly calls single-payer insurance. How many of his supporters have done their own research to inform themselves of these plans, which can total as much as $400/month (yes, $5000/year)--and rising? That is the Achilles heel Biden should be focusing on. How would Americans be transitioned from their employee-sponsored plans to Medicare? All at once? Gradually? If so, how? When and how would the ACA be eliminated, and its recipients picked up by Medicare? I have not heard these questions addressed. And how quickly could Medicare be brought up to scale to handle millions of new members? More questions for Sanders.
Biden's plan has the advantage of beginning with the ACA, and targeting and improving its areas of weakness. No one would lose coverage during a period of transition. The choice would be voluntary. The ACA is popular with Americans, and it is likely that more would join given the opportunity. None would be forced to give up employer-sponsored plans if they chose not to, so the transition would be more gradual and the initial burden on the ACA minimized.
1
I am wondering why. the author doesn't address the big flaw of ACA - employer-based insurance. None of the countries he mentioned and many other have employer-based insurance, which creates incentives for insurance companies to cater to organizations rather than individuals, not to mention creates very unequal access to medical care , and therefore, divided people along work line. Sanders plan deals with this huge flaw in the American healthcare, while Biden plan does not. Biden plan leave in place the guess work for people on ACA, when in beginning of year, they have to know how much they will earn and would they qualify for subsidies and how much. It also not clear how he will find the expansion of services and subsidies. Wouldn't that require new taxes as well?
1
No doubt corporate greed and politics are laced through our medical insurance systems. They are eroding the health of our citizens but we can't just throw out private insurance for one very significant reason: it employees a lot of people. True leadership, patience and willingness on both sides of the aisle are needed to slowly but systematically disassemble the system. It ain't gonna be easy and there will be a fever pitch hysteria from the conservative media and the Wall Street tycoons. I hope we have the strength. Remember insurance companies mostly process paperwork. In many other countries government employees do this work and it is a much fairer system. Breathe deep.
The real problem with single payer is getting there. For the near term and most probably for the life of current employees, there would be a big financial hit.
Single payer means that their benefits through the company effectively go down, but their salary does not increase. They would not only be paying the new higher taxes, but their pay package would not have adjusted to a higher salary to compensate.
To make the shift work economically for a significant portion of the population, it has to be gradual.
Most voters have a sense of that. Until Democrats address this issue directly, independent voters especially will be leery of their arguments.
2
@Debbie
One line in a healthcare reform bill:
"For employees switching to universal healthcare, all monies paid to their health insurer will henceforth be added to their pay check."
Done!
Really? My institution pays over 20K a year for me and my family. I don’t see them giving me those dollars. Nor would any other public institution - public schools, universities, etc. I feel lucky to have what I have, a PPO with a reasonable deductible (5K).
@Jethro Can you name any candidate with this as part of their currently expressed proposal for health care?
1
If you don’t qualify for a subsidy, the ACA simply offers very expensive plans with all the usual complications of the deductible, co-pays, and out-of-pocket maximums. When Bernie Sanders explained his health care proposal at a Fox event to a Fox audience, a sizable majority said they would leave their current coverage to join his plan. Bernie’s plan isn’t radical, it’s common sense. Who is opposed to it? Corporate interests that would lose money. I care as much about their financial interests as they care about mine, which is to say none. So, Average Joe and Jane has a choice to make - they can add to their own wallet, or they can enrich the corporations championing the current system. Take your pick.
2
"Medicare for all" is misleading, as is this statement - "More than 100 million Americans are covered by Medicare or Medicaid, which are both single-payer programs". Yes, millions of Americans rely on Medicare, but on its own the coverage is fairly minimal. In fact, if someone only has Medicare and faces a serious health problem, they could go broke paying for (or attempting to pay for) the numerous procedures, tests, medications, and hospital stays they would face. Most people on Medicare have supplemental coverage, much of which is offered by private insurers. So the reality of Medicare is that it is already a blend of public and private insurance. How will this model be upheld or changed with the promises of "Medicare for all"?
4
This writer makes an important point. In addition, my Medicare is through a private insurance company, United Health Care, although my premiums are paid to UHC through deductions from my social security.
1
My local television station just did an investigative report on the high cost of insulin, to inform viewers of some possible avenues of help outside of insurance. In the course of the investigation, the reporter interviewed a family with three sons who are diabetic. Their annual out-of-pocket costs for insulin and related supplies is $19,000.00. The husband has a decent job with insurance that the reporter characterized as "good." So, $19,000.00 annual out-of-pocket costs for essential medications, along with premium payments, is considered good insurance in this country. I suspect that Bernie's single payer tax would be significantly less than that.
Instead of bickering over whose plan is better or railing against corporate greed, I wish the candidates would explain how their plans would address the real problems that real people face in obtaining essential medical care.
4
@CH,
Insulin was the first peptide hormone to have its amino acid sequence determined (in the 1950s). Insulin can now be produced in yeast, which can be grown in large-vat quantities. That's been true for about 20 years. By now, insulin should be about as cheap as aspirin. The high cost for American diabetics is highly suspicious.
2
People die when they have no insurance. People die when they lose it. Please Dems, no infighting!! Anything we can get or retain is better than what we have or could lose.
If moderator asks you whether to go for Medicare for all or some private system, please tell them: We shall see what we can get and do, and we will do the best possible.
First thing, make sure that Reps lose the election and that Dems have opportunity to make it better. What arises then depends on margin of victory and what is doable.
Do NOT let these secondary considerations on details, albeit important ones, detract from the main goal, some type of insurance for everybody.
4
Not surprising that Sanders would attempt to paint Biden as a pawn of corporate interests. That approach worked so well against Clinton that a lot of voters sat on their hands and allowed Trump to win the Electoral College vote.
That said, Biden does have significant corporate roots. Delaware is a favorite state in which to incorporate your business, and Biden is certainly not an economic crusader. Sanders, for his part, has a solid reputation for expensive plans that have no economic underpinning beyond "tax the wealthy".
I'll vote for whomever the Democrats nominate, but I hope that neither of these two is chosen.
1
I hear this comment often but I don't know anyone who refused to vote because they only wanted Bernie. Can someone cite documentation for this claim?
But, this healthcare issue between Biden and Sanders is an excellent discussion on how far and how fast do we want legislation to move on any issue. Biden supports an incremental approach to legislating, while Bernie is an all at once flush what you are doing today and do it this new way tomorrow approach.
It is easy to get lost in the weeds on most issues especially healthcare, but the real debate now between all of the candidates is what issues are most and least important to you, and how fast and how far would you go in your administration on those issues.
Personally, I think Bernie's approach is too much all at once, and Joe's approach is just too small and too slow.
Why is Medicare described as a single-payer system when it is not? Everyone on Medicare pays Part-B out of their Social Security check and Medicare pays only 80% of the actual costs of medical care. Anyone who can afford it buys supplemental insurance to cover what Medicare does not. It is a multiple-payer system.
5
@William Horns Medicare is single payer for what it covers, which doesn't include dental, vision or hearing. Supplemental plan are not mandatory. 19% of Medicare beneficiaries either do not buy or cannot afford supplemental plans. Including supplemental premiums, the average Medicare beneficiary paid over $3,000 out-of-pocket in 2017, on average about 40% of income. Poorer beneficiaries who live only on Social Security without supplemental plans pay an even higher share of income on their health care costs. As Krugman notes, Sanders' plan provides comprehensive coverage without co-pays, deductibles and premiums, which is why it costs so much.
While it is painful to see Democratic candidates infighting, which can only make unity harder down the line, at least the debate over whether to preserve the ACA or change to universal coverage is a valid one.
On the other side, Trump continues to lie that his party will unveil a terrific new alternative which clearly doesn’t exist. Even McConnell isn’t really playing along, saying that he looks forward to seeing what the president will propose.
The worst behavior is from the Republicans, scheming to take away guaranteed, comprehensive healthcare entirely.
370
@NM
I don't think it is painful at all friend, because ''debate'' is the foundation of what a strong Democracy is all about.
Remember that once we get rid of all of the republican ways of blocking everything - especially regular order, then we can go back to that debate on the floor of the House and Senate, with straight up and down votes.
All of the Democratic candidates can pivot to what I just said, and portray that we are stronger for different points of view. (if we can act like adults and talk back and forth in an orderly fashion)
Just a thought.
41
@NM
Yes, Trump is going to unveil his magic health plan later. Just like he unveiled the plan he promised to unveil during his last campaign, or just like he unveiled his taxes as he said he would.
34
@NM, But calling a fellow candidate a liar is not a debate.
18
I have lived in Italy France England. Never had a problem . At that time I was also younger and that’s a point that is rarely mentioned. In a system that covers everybody and everybody pays into it the costs of running it are more equally share . Medicare and Medicaid are restricted to the most expensive segment of the “health care” market while the for profit private insurers get the less expensive segment. I have private insurance through my wife’s employer and I had private insurance through my own employer in the past and I can tell you that based on my experience the care I received has been at par at best with the care I received under the universal healthcare systems of the above mentioned countries.
2
This is what gets me, the prices that hospitals and doctors services charge. I haven't heard anyone talking about reducing costs, not just the insurance aspect but the fact that different hospitals all over the country all charge a different price for the same procedure, Xray, scan whatever it may be. It is also the fact that healthcare is so much a for profit industry in this country. I have heard tales of women being charged $30 for a couple of Ibuprofen after having a baby. How can that be justified. Personally, having come from the UK, I would like to see much more government run healthcare with an option possibly to upgrade with some insurance.
262
@Sally MI agree with you that it would be desirable to end 'For Profit Healthcare' in a new status quo where single payer government runs healthcare and where there is no basic need for the healthcare insurance industry anymore other than privately upgrade them who wish and can afford it for additional benefits.It will be long overdue that the government will be able to negotiate medicine- and drug prices with Big Pharma having the leverage of a couple of hundred million insured people - something the Federal government is now forbidden to do by a law for its Medicare beneficiaries, instigated by the far reaching hands of the Big Pharma lobbyists years ago-. When deductibles and co-payments are no longer extra expenses on top of healthcare premiums already paid, but will be replaced by income related taxes it will really mean a fresh start for American Medicare for all at last. The transition to this new status quo will be met with already noticeable resistance from the established moneyed interests in the Insurance and Pharma industry. I guess that will be a problem for another day when a Democratic sun shines on both Houses of representatives.
17
@Sally M
No to the upgrade. Here in America, the upgrade would become necessary because the basic plan would be so bad. Then before we know it, no one would like their health insurance because it is so expensive and doesn't cover anything and forces them to buy extra coverage. This is how capitalism works in the U.S.
16
@Sally M,
Compare the "sticker price" with what Medicare pays, and even then we old folks need Medigap to cover the deductible and copay, and where do we get it? Private insurance. And increasingly, providers are refusing new Medicare patients. We need a lot of reform, that's for sure, and Medicare for All is not sufficient. What is needed is getting the profit out of health insurance and the provision of health care. READ MY LIPS: NOT FOR PROFIT and I really don't care how we get there.
32
The real question is how we divide up the 3.6 trillion dollar in 2018 for health care. To say we cannot afford whatever plan we have is a red hearing because again it is the total cost of health care that is being paid for.
The next question is not what plan but how do we get there. That is change how we divide up the paying for health care. Or how do we assess each person for health care.
I have government single payer system called Medicare. My health care is paid out of three buckets, government taxes I paid into when I worked, my monthly payment to Medicare and my monthly payment to private insurance.
What each person pays individually is not what we should focus on because most people don't understand who is paying the total bill of their coverage. If you divide the 3.6 trillion by 350 million people you get the true cost per person that medical care costs.
2
It is pointless to have these arguments about how to get to universal coverage. I don’t know why people don’t learn that what a presidential candidate promises and what gets delivered are never the same, especially something as big as health care. It will all have to get through Congress. Democratic candidates should all say:
1) that we need to ensure that everyone in the country has access to medical care that they can afford and can never lose.
2) should make it clear that many of the problems with Obamacare are the DIRECT result of Republican sabotage
3) make it clear that if we want better, more affordable care, we must elect Democrats at every level of government and have majorities in House and Senate as well as a Democrat as President. Even then everything is at risk because of conservative court stacking.
Only if we get control of all legislative and executive branches will it make any sense to argue about how to achieve full, affordable health coverage. At that point, we should go for a plan that gives the most care at the least cost.
Don’t get me wrong, I would prefer a system like the UK, but it isn’t practical here. I lived in Australia for a while and experienced single payer with private insurance supplements. It worked fine and certainly is something we can do here.
Of course if we don’t take dramatic action to curtail climate change it won’t make much difference. Democratic candidates should also make that clear
403
@Sandy of Reality writes:
"Democratic candidates . . . should make it clear that many of the problems with Obamacare are the DIRECT result of Republican sabotage "
That is the most important thing you wrote. I don't think it can be emphasized enough. Like Bill Maher said, the Democrats should pick a slogan (or just a few) and repeat it endlessly like Republicans do, instead of a large number of different sound bytes that get lost in their own multitude.
This should be their message primary [no pun intended] message.
And I would change "many" to "most."
33
@Sandy--I definitely agree with your third point. In my state we have a Democratic governor, both senators are Democrats (and both women!) and many Democratic members of Congress. And, the ACA works great. State officials estimate the number of uninsured people in Washington state has dropped below 6 percent. More than a quarter of the people who are bought insurance through the Washington exchange are 34 or under, and sharing the risk with older, sicker people keeps the costs down and the viability of the program up. Although consumers don’t have a choice of insurance companies in some counties, if companies no longer had to fear that Congress or the president is going to kill the ACA more insurance companies would get into the marketplace. When state governments support the ACA, people in the state win. It's that simple.
33
@Sandy
" people don’t learn that what a presidential candidate promises and what gets delivered are never the same"
I remember, during the 2016 campaign, hoe Trump promised his supporters that he would tell Congress to change a constitutional amendment that Republicans don't like. Congress does not have the power to change amendments, but of course his uneducated supporters didn't know that. I knew that Trump was a liar from back then.
16
“Persuading them that this would be an improvement, even if true, would be a tall order.”
This is really the biggest lie pundits on both sides spout.
I’m a normal person who talks to normal people of all political persuasion. I have not met a single person in over 20 years say they like the American system - with the exception of my mother who has been on Medicare since the mid 1990s.
Saying we can do another run at a hodge podge system is also practically a lie given the concentration of wealth, greed and ownership by Big Money - they’ll just sabotage that effort all the same. That’s why “medicare for all” is the best political position because its simple.
Those people in private plans, if they live long enough, all end up in Medicare. They know it, you know it, and nobody’s complaining about that fate.
The tax increase is also a soft sell: your taxes will go up a nickel but what you pay for healthcare overall will go down a dime. In the event you will be guaranteed, for the first time in your life that you actually are covered no matter what happens, at any age. In fact everyone you know, care and love will be covered from cradle to grave. All for half price of what you pay for now.
Yeah, that’s a really hard sell.
That stuff about people not wanting to give up their private plans is a rich bunch of carbon fiber - they already are giving them up, after they turn 65 or 67 or whatever age it is now.
308
@Tim Kane
Also, I have not met a single person who says they like, let alone love, their private insurance or the American medical system. I would say that it’s much closer to 90% or more that hate it.
The way the media and its pundits are trying to spin the choices before us give credence to Trumps “fake media” meme. Please stop it.
Now.
46
Medicare Relies entirely on private providers.
11
@Tim Kane. I think your assessment of Medicare is correct. However, I do not think that would be a winning strategy for Nov. 2020; too many people would see it as revolutionary. Like so many, my objective is removing trump from office so that our nation CAN become become great again!
22
Until this country begins at the beginning, many of our citizens will go without health coverage. We must level the cost of college tuition for undergraduate and graduate schools - ie. for the M.D.s enrolled therein. These folks graduate with a tremendous debt to begin with. Eliminate that, and we're halfway there. This is not a plea for free anything. Just level the costs.
4
So much of the Biden/Bernie dust-up seems like a "less filling/tastes great" debate. The fact is, there is a consensus among Democratic voters for the type of health care plan they want to see. These childish spats between these two men do nothing but demoralize Democratic voters. They each need to put forth their plans, and then let the primary voters decide.
And both candidates can forget about Trump voters. They didn't vote for him because of any affordable health care concerns. They voted for him because he is as racist as they are, and they love it.
So Dems would do well here not to waste their time "reaching out" to Trump voters anyway. Trump voters would rather see their own families suffer under skyrocketing health care costs, than to give up their racist "president".
As Dr. Krugman notes, there are several very workable health care systems in western countries, systems that have worked well for decades. We might borrow from those, or fashion our own, taking elements from those systems. In any case, Democratic voters want to know exactly what both Biden and Bernie -- and Liz Warren, for that matter -- are offering, and then they'll vote accordingly.
By the way, these infantile spats seem not to have hurt these two men at all. Would the press and the public be as kind as Liz Warren, if she engaged in this immature behavior? If Democratic voters want the real adult in the room, they would do well to start giving Liz Warren very serious consideration.
177
@Charles Dodgson
Neither Biden nor Sanders can match the skills or experience Elizabeth Warren would bring to the Presidency. For example, the Consumer Protection Agency was her successful attempt to improve the lot of real people - until Republicans managed to get rid of it.
I have been delighted to see citizens respond to her with standing ovations at her many town hall meetings. Wall Street needs a leader who knows the ins and outs of regulation to restore sanity to our financial world.
Please be informed.
48
@Charles Dodgson
The Trump voters Krugman is talking about are the ones who voted for Obama (so apparently not too racist or GOP loyalist), and then switched to Trump in 2016. No Dem will win the hardcore Trump supporters, but there are plenty who voted for him because they couldn't stand Hillary Clinton and are now having buyers remorse. Those swing voters, especially women, could be the deciding factor in 2020.
15
@MGL
How can Warren regulate Wall Street when she's openly said she'd take their money in a general election?
3
People seem to have forgotten that the Massachusetts mandatory health care initiative (under Governor Mitt Romney) was the model for the ACA. It is entirely private insurance-based except for those covered by Medicare and Medicaid. For 2018, the Massachusetts average monthly premium was $385, compared to a national average of $600 a month, making MA the lowest in the country. Since 2006 People love it and it is a complete non-issue in MA. If the Republicans would have stopped lying and obstructing the ACA, this would be the situation in the entire country.
3
Here is the real story, which Prof. Krugman realizes, but hasn't said explicitly. The problem is not that we have private insurers--the problem is that we have for-profit private insurers, in whose interest denial of coverage--based on pre-existing conditions or a whole host of other reasons--causes more of the insurance premiums to go into their own pockets instead of paying for health care. The good professor cites the Netherlands, which in 2006 moved from a Bismarckian employer-based (not-for-profit) system to a multiple private (not-for-profit) system, where the different insurers can compete on the quality of providers they have contracted or geographical concentration of providers, but not on price or on the basic basket of benefits covered. And a full year of insurance payments by a Dutch citizen is about one month's worth of coverage in the United States. I know. I lived there and worked in health services research here and there.
62
@beaujames 'Denial of Care' is the prevailing 'Standard of Care' in most of the United States these days. One only needs to look at some of the EPIC evaluations that Nurses and Doctor's input into the system to see their rationalizations for 'No Care' at all. That is the Dirty Little Secret that no American wants to talk about. And even if you have private insurance, Denial of Care is still the standard. That's why people are leaving the United States for foreign countries like Thailand and pay out of pocket to ensure they get care. They truly know what's important for themselves and aren't risking it with 'American health care.'
14
@jayhavens, We agree, except that the reason all of what you say is true is because the private insurance is for profit. And this is the point. If you want private insurance instead of single payer, it can be done if you get rid of profit in health insurance (and health care provision as well). And that is what everybody in the developed world except the United Corporations of America knows.
12
I agree with the problem of for profit insurers. people also get confused between the payor / insurance arm of medical care and the health delivery system, the doctors and hospitals which deliver care. they are not the same thing. they are related. I think that multiple not for profit insurers are fine. I do not think that for profit insurers make medicine better. they are, as the sma says, interested in the profit, not the care.
8
Professor, please stop emphasizing Capital T Taxes as an impediment to decent health care. Bipartisan analyses have long made clear that most people would pay considerably less in taxes under various health-care-for-all proposals than we currently pay in premiums, deductibles, copays, and unreasonable denials of payment for care that our plans were "supposed" to cover.
I for one would rather pay a routine tax that I can budget around instead of holding my breath with every medical check-up or new symptom, wondering whether this is the year I'll be bankrupted by an unexpected health event.
344
@Betsy Todd I surely wouldn’t. The very progressive ‘Pod Save America’ did a basic explainer on the tax increases necessary for a public option and M4A. I would pay more in taxes for a public option with an enormous deductible, and M4A would cost even more.
By his own math, Sanders’s plan would cost over $3 trillion per year. This would almost double the entire budget.
To put this in other terms, it would cost 10x the Republican tax cut, and 6x the Iraq War. M4A is very, very, very, very, VERY expensive.
7
@Betsy Todd
Spot on. This is where proponents of single payer healthcare or other forms of universal healthcare fall flat every time. They don't explain that while yes, you pay more in taxes up front, you actually pay less in the end. These needs to be explained in dumbed down terms and plastered all over the media by proponents.
34
@Mercury S
And yet every other advanced country in the world is able to offer it without bankrupting their economies and citizens/residents?
55
Gradualism is the key. Let those with private insurance keep it if they like, together with the ever present fear that their doctors or hospitals will go "out of network" when the company changes carriers. All others can go for the public option.
If my 32 years in Corporate America has taught me anything, it is that large companies have been dying to offload pension and healthcare obligations for years in the name of global competitiveness and profit. Witness the Wal-Mart model where you keep a force of part-timers and help them apply for government benefits because their wages are so low.
The transition to Medicare for All will happen naturally. Companies will simply stop offering their own plans. Look at what happened when IBM set the pace by eliminating defined benefit pension plans. Other corporations fell like dominoes. You would be hard-pressed to find one today.
I hate seeing perfectly good Democratic candidates alienate themselves from much needed voters because healthcare purism is a sticking point.
236
@Ray Barrett
Many of those "much needed voters" are from states that have a higher percentage of uncovered and undercovered people and that refused Medicaid expansion. They're "gradually" getting sicker and dying or spending all of their savings and going into debt. They don't have that kind of time.
12
@Ray Barrett amen. I used to analyze pension & benefit costs for one of the largest utilities in the country, including forecasting costs & writing testimony around that forecast for rate cases. I am certain that most of Corp America would LOVE to offload the health insurance portion of compensation. It's very hard to get your employees to believe that the budget for their raises went into paying the 20% increase (year over year) in health insurance premiums - they get cranky.
19
@Ray Barrett, Gradualism sounds nice, I agree. However, it seems doubtful that insurance companies would continue to provide the private insurance plans that they provide now, once the public-option writing is on the wall. Especially if public-option plans were more attractive to many consumers, as would likely be the case. Consequently, the possibility of a smooth transition period may be an illusion.
A poll from ABC News - Washington Post showed 83% of registered voters who support universal healthcare support replacing their their private insurance completely with Medicare for All.
At a recent Fox News Town Hall w/ Sanders, it showed in real time people being asked the same question -- if people support giving up their private insurance from their employer for MFA -- and the crowd erupted in cheers. Quite to the surprise of the Fox News hosts. It was filmed in conservative Lehigh Valley, PA.
The least secure insurance plans I have had in my life (and I think I've been on every plan except Medicare at this point), have been through my employers. Huge deductibles, narrow networks, and the plan would change every year anyway because I changed jobs or the employer changed plans. This reflects the experience of the 66 million Americans who change their plans each year because of changing jobs.
I think this frame from Krugman is not keeping up with the experience people are actually having with private insurance. Medicare for All is a very popular proposal despite how the NYT frames it.
5
Sanders has never been interested in the detail of governing. Biden is just plain not viable. We’ve already seen how how pre-nomination rancor can hurt in the election. Neither has a real chance of winning, but both can sure do damage.
We need a viable centrist candidate and Elizabeth Warren on the left to see where the rank and file want the party to go. The sooner the better.
3
It's a fact, as Krugman notes, that a lot of other countries have health-care plans that work -- for all their citizens. Why, then, is is it so hard for the U.S. of A. to take a similar approach? I betcha the reason has a lot to do with campaign contributions and corporate greed.
1054
@Alan C Gregory I don't doubt campaign contributions have had a huge impact but it primarily occurs at the state level. The biggest problem with health insurance has ALWAYS been with the states. As Medicare and the ACA has shown the federal government can have a huge impact if its' powers are applied appropriately. However, until future proposals shake out states can take control of their own health care futures as shown by Massachusetts, Colorado and California. Citizens should be actively pushing their state legislators to allocate more money for health care and challenging the status quo in their state. I am talking about you Alabama...where a single company provides 97% of insurance for private individuals (not included in group/corporate plans). How is it that in a good Republican state ONE company has a monopoly on individual health care plans? I wonder who is getting paid off???
35
No many of the failures perceived in the ACA being modified from the federal program or the outright refusal of some states to accept insurers who would have made it whole in their state. Ifvwe are to have a single payer system as a choice for each citizen, it. Must be available as a universal program equally in each state.
16
@Alan C Gregory
I believe it has more to do with American "rugged individualism" that anything else. We have a hard time paying for anything that does not directly benefit us. If we truly cared about the "common good", we would have better infrastructure, better k-12 education, and better health care.
Any attempt to build workable systems for the common good get labeled as "socialism" before they can be implemented. All of our myths about "rugged individualism", "go west young man", "anybody can be President", etc. have turned us into a nation of competitors instead of fellow citizens.
Perhaps, because being "American" is an idea and not an ethnicity, it keeps us from thinking about the common good. We think of "me", not "us". Anyone who participates in programs for the common good is a "taker" as opposed to a "maker". There has to be a balance and we can't seem to find it.
51
I recently spent 9 days in the hospital after being diagnosed with a rare kidney condition. The doctors would not release me until they were sure I could survive at home on my own. The insurance company refuses to agree that this was necessary and so will pay for only 4 of the 9 days. After paying my insurance premiums for every month for 30 years and never being sick or hospitalized, I now find myself at home with a debilitating condition and a hospital bill that will probably exceed $50,000. The one time I actually needed my health insurance it failed me. Something about this system can't be right.
1834
@CDR Fight your insurance company, you will win in the end, but they put roadblocks in your way to wear you down--also fight with the hospital-do not pay these bills- the hospital and the insurance company must duke it out not you.
Good luck it will be a nightmare, but you are in the right (if what you say here is true)
336
DJM,
I don't mean to discourage CDR from taking on this fight with his/her insurance company. He/she definitely should, but my insurance company refused to pay for acupuncture to treat Bell's Palsy. My neurologist went to the trouble of writing a one-page letter to no avail. I made numerous calls to no avail. So not only did I pay out of pocket, my acupuncturist told me if I had started my treatments right away instead of waiting three weeks since I was fighting with my insurance company, I probably would have gotten better results.
57
@CDR Fight the insurance every step of the way. I believe it will eventually give in. Insurance companies count on people giving up. Never give up, never gie in.
149
Single payer is best but winning the election means not going down that road in 2020. Big pharma big ins and Wall St too powerful
1
"The healthcare debate will take place after Trump is defeated and on the way toward getting a Senate that will work with the House and Democratic President _________ . "
That must be the message of each Democratic candidate. Attacking various policy proposals on healthcare and the other candidates as favoring corporate greed or dangerous socialism or as a big government scheme to take away your private insurance will hurt whoever emerges as the Democratic candidate in the general election.
The debate format favors short answers that only generate viral memes that misrepresent or lie outright to create fear, misunderstanding and ammunition for the Liar-in-Chief.
Why must Democrats be required to spell out every single detail of their positions.? Let's remember Trump's words on healthcare: "We're going to come up with something fantastic for everyone on healthcare. Lots of beautiful plans that the people are gonna love."
3 years later we have nothing from Trump, not even more empty promises.
The Democratic candidates must run on a pledge to make affordable ,universal healthcare for all. Period. Full Stop. And if Savannah Guthrie or Rachel Maddow or Jake Tapper don't like this answer, they can pound salt,.
They must, at every opportunity, pivot and turn every discussion back to Trumps fake promises and lies --"We can't have a country that has a liar for President." That should be every candidate's coda and closing statement.
6
I get the feeling that Krugman is trying to be "fair and balanced" by criticizing Biden and Sanders equally, when he knows darn well that Sanders is the worst offender as far as false promises and demagoguery. Dr. Krugman knows that a great many Bernie supporters read his column and he wants to "be fair" to Bernie. No, Dr. Krugman. Sanders is the offender with his pie-in-the-sky trillions of dollars budget buster of an impossible dream. Biden is making a foolish argument. If he just stuck to the realities of the situation, he would be doing a better job of persuasion. Always choose the truth over political expedience.
4
Biden keeps looking backwards and is too corporate for me while Sanders is too simplistic, he says little beyond his spot-on-stump that corporate greed is ruining the country.
Too bad that they are engaging in GOP rhetoric against each other.
Also too bad that Biden and Sanders do not get to debate each other.
1
Rename the piece to Sanders behaving badly. You are touting one’s plan over the other, and the title is misleading.
2
The perfect is the enemy of the good -- take heed Bernie and Medicare for all crowd. Centralized policy makers have little feeler appreciation for what their actions will mean on the ground as individuals experience it. And like all matters of policy, the devil and I mean the real scary ugly devil is in the details.
1
This is just wrong in a strikingly obvious way. (Note that I'm a Warren supporter, so no dog in this fight.) Biden's plan would maintain a corporate presence in healthcare. Corporations are legally obligated to maximize their shareholders profits--in other words, to be greedy. So, by definition, Biden's plan would not purge corporate greed from the system. You may think that's a political necessity, and you may be right. Perfectly valid debate that needs to be had, but could we at least not make things up about candidates making things up? You may also disagree with my definitions, also fine. But to say that Sanders is not playing fair or honest on this is still a gross distortion.
2
Trump continues to smile while the Dems argue over which healthcare plan is better. Sanders is a fake with his Medicare for All plan. It is preposterous to even think it is a viable plan. Biden is like the GOP, no alternative, so just improve what we have. Yet the Dems are going to waste their time arguing healthcare over and over again. Those who are on employer provided plans are happy, and that is Trump's base, and it won't change. It is why the GOP doesn't have to come up with an alternative to Obamacare. So, the GOP continues to whittle it down stating it is too expensive. With so many real problems today the Dems waste their time arguing about healthcare, something that is a dead issue. It is why they will be dead in 2020.
@Me Too Trump's base is on Medicaid. The GOP moderates are on corporate plans. Why they can't see that the ACA is the only thing standing between them and catastrophe if they lose their job or bankruptcy if they come down with an expensive-to-treat disease is beyond me.
Me Too, Good Morning. Everyone loves their private-corporate plans until they find themselves out of a job for some reason or another............my COBRA for a family of three is $1,200 per month. It's more than my mortgage.
Almost no one comments on Krugman’s main point, the sad nature of the interaction between Biden and Sanders and in turn the Democrats as a whole. Wake up people, you are going to give us 4 more years of misery!
3
What's not to understand here? Insurance contributes zero to your healthcare. Z-E-R-O. It's time to call a spade a spade and send it to the dustbin of history with one clean sweep. This one change will benefit every American citizen...equally, and their kids and grandkids–for life. Sanders is the only one advocating this. He's my guy and will continue be my guy. He's the real deal. The original. As for Joe, he's living in the past. I feel for the guy. But truth is, he's barely coherent. He should drop out sooner rather than later. The rest are late bloomers and hanger-oner's. Health Insurance be gone!
1
Every poll shows that forcing people to take public insurance and to pay higher taxes so that others will get insurance is a loser. It takes what can be THE winning issue in this campaign and turns it against us. If Sanders is the nominee then we will lose over 40 states. Trump will win in a landslide, and Democratic congress people will desert the the candidate in droves. What Biden has said to shoot down this catastrophe may not be 100% accurate but he is fighting to save what is left of this country and has to be concerned that the press will give Sanders the 90% favorable coverage it gave him last time. As I see article after article about Biden and busing but nothing about Sanders support for Marxist Leninist states ....I can forgive Biden for playing dirty.....Hilary didnt and your paper tour her apart.
3
Mr. Krugman, with all due respect, do you yourself ever worry about things like being ‘in-network’, deductibles, co-pays, lifetime limits and the like when you need health care? I thought not.
2
If there is a feud, it was started when Biden misleadingly claimed that Sanders would end ACA when he clearly knew that Sanders was proposing a plan that would remedy the weaknesses of the ACA, As for independent estimate, you are playing the trick of cherry picking your studies. Here is one by the University of Mass. that claims the M4all could save trillions. The study is several hundred pages, and endorsed by many economists: https://www.peri.umass.edu/component/k2/item/1127-economic-analysis-of-medicare-for-all?_ga=2.110984070.2098703806.1563835546-305746595.1550896577
When you say that M4ALL is a n electoral loser, and warn Harris and Warren to pay heed. The punditry is speaking here. Here is a poll showing the popularity of M4ALL and there are others. The private insurance question in polls is misleading. https://morningconsult.com/2019/07/02/majority-backs-medicare-for-all-replacing-private-plans-if-preferred-providers-stay/
In fact, M4all is more popular than the ACA, which does not even have 50% support in the latest Kaiser polls. The Swiss and Netherlands systems are much closer to M4ALL than to Biden's plan. your praise of Biden's plan of offering all these great things for just 750 billion, and 97% coverage is simply false. It will not offer affordable coverage. Remember Obama in 2008 advocated a plan, as opposed to Hillary, without individual mandates. Biden's plan when examined falls short in promise and in practice will fall seriously short
1
Single-payer works fine here in Australia. But the additional private health insurance system (the one we had to have to be like you, America) is a fat parasite, costing the public billions each year in subsidies and never actually managing to pay the full cost of medical procedures and prescriptions for those insured.
Bernie Sanders is trying to bring America in from the cold. He's telling Americans that they don't have to accept rank profiteering in healthcare, even if they are already long-used to accepting it. His message is one that I hope Americans can hear. It is a message that Australians need no convincing of.
1
Trump and his GOP want to repeal the ACA and replace it with nothing. Many of us have serious medical conditions and are on Obamacare. We worry that Republicans are poised to strike down the law in the courts and that Democrats will have insufficient power after the 2020 election to reinstate it.
If that happens, I would have no choice but to become a medical refugee in another country, probably as an illegal immigrant. I do not want to leave my country, but I feel as though my country is leaving me.
I would have one consolation. Other countries would treat me with humanity. I would not be stuffed into a cage, packed so tightly with others that I would not be able to lie down to sleep, or with the lights constantly on so I could never rest, or with the stench of human waste incessantly permeating the air.
Why is America becoming so inhumane?
Why is America letting its own citizens needlessly get sick and die?
And yet … could there still be hope? Could Democrats stop fighting with each other and unite against Republicans? Could they get to work on that now?
How about shoring up Obamacare first? We can talk more about Medicare for All after the election. Democrats are still on the road to recovery after 2016. We need to remain rational and focused and work together to win this race.
Do we still care about taking care of one another? If so, Democrats still offer us our best chance.
1
“It’s time for both men to stop poisoning their own party’s well.“
Look, if the questions by the moderator are as toxic as in the last debate, the dems and democracy itself will need immediate health care.
1
Putting the words "corporate greed" in parentheses is disingenuous at best, Dr. K. All we need is to compare drug prices in the US with those around the world to recognize how severe this problem is. And to suggest that Mr. Biden is not part of the same traditional system of Democrats winking at corporate malfeasance is just as bad - it's one of the biggest reasons many Americans turned their backs on Hillary a few years ago and voted instead for the most classic example of a snake oil salesman.
If we're going to talk about honesty, let's do so.
1
And you have fallen into the trap of bothsidesism. Joe Biden does in fact accept contributions from health insurance executives and even attends fund raising events hosted by them. Joe Biden has even driven by informational pickets placed by a mental health workers union protesting Kaiser Permanente's underfunding of mental health care to attend a fundraiser hosted by a Kaiser board member. https://www.huffpost.com/entry/union-plans-picket-of-joe-biden-fundraiser-hosted-by-kaiser-board-member_n_5cd1c051e4b04e275d510425
Biden's proposals sound wonderful but he was part of an administration that caved in to the health insurance industry and failed to enact a public option in the first place. Why should we believe that he will stand firm now?
1
Utter nonsense. Two candidates with differing positions, criticizing each others proposals. And what's wrong with that?
At 73 years old I must admit I am at times a crotchety old man and of ill-temper. Be that as it may, I do a whole lot better at channeling these traits than either one of these old fellows.
One of the keys to success in this regard is self-effacement and the ability to laugh at myself in front of others. So most people think I'm funny and like to laugh along.
Sanders and Biden take themselves far too seriously. They appear almost always to be cocky, egotistical, and attention-hogging. Neither is the picture of the great man. Often they come across as small and/or mean.
While I'd vote for either over who we have now I certainly hope and pray that neither one gains the nomination because alongside you-know-who they appear effete "weakened, enfeebled, enervated, worn out, exhausted, finished, burnt out, played out, drained, spent, powerless" and that just won't cut it next year.
In another 14 months each may wilt even further. Matched against a steroid-driven maniac fine-tuned for gross take-down they lose badly. God forbid.
Still and all the central most pressing issue is healthcare. Ought we not have it for everyone in some way, shape, or form?
We need to dissect this problem and at least go singlepay and I'm sure Warren will rise to the ocassion going forward. She is the obvious candidate of choice and along with right running mate (I take Castro or Buttigieg) we get a new president next November.
Fair taxing of the rich alone would fund a large part of a new system
3
Excellent column.
I like both Biden and Sanders' proposals. I prefer Biden's since I believe it can be a winner. Sanders' proposal would please me but is a loser.
1
Another weekend of seeing most of my comments not printed.
It is time for those who want universal coverage to start understanding the obscenity of Medicare for those over 65.
I have US Medicare which I never use but American thinking cannot deal with the fact for a psychologically healthy society taxes paying for the healthcare for the elderly is the worse way to spend healthcare dollars.
I remember the old B+W Titanic movie and the almost empty old geezer lifeboats and the Women and Children First signs.
I understand that America hasn't got enough money to take care of everybody but what kind of insanity says to spend that money on people like myself whose productivity and years of production are not likely to improve regardless of care when money spent on children and young women will be recouped by decades of productivity.
If taxes are paid to give healthcare to only a section of the population surely seniors should be at the bottom of the list.
Especially since it is all about the GDP and the Dow.
@Montreal Moe
Right. So the seniors who paid a fortune into Medicare now get to drown? We've worked 40 years. I want my damned Medicare. I paid for it.
Can Joe Biden and Bernie Sanders go far in their debate about this subject and others?
Here's a simple solution, 60 cents of our tax dollars go to the pentagon to make insane amounts of weapons of mass destruction. Lets make it 30 cents to the pentagons black hole of death and use the rest to fund single payer health care. In this way our taxes won't go up and it will give us something we can actually use instead of all out hard earned tax $$ going to Lockheed Martin and Boeing.
6
@Greg Ah thats' way to simple...you think NYT will pickup on this and like make a drawing and like publish it every few weeks. Off course not ..the good old boys club would be on the phone complaining how outrageous they (NYT) have become.
Excellent, easy-to-understand column on a difficult and complex subject. (Who knew?)
Thanks, K-man!
I'm a Bernie Bro, but I think Uncle Joe's second-rate idea has a first-rate chance of putting a D in the White House. Conversely, Bernie's first-rate idea is a third-rate idea for putting a D in the White House.
"Reality Bytes" was a pleasant movie, and its title is an uncomfortable, yet wise message for today's politics, specifically, you can't always get what you want. (Curses, foiled again!)
Both the Bern and Uncle Joe are behaving badly in even staying in the race and helping King TWIT to another 4 years...as are more than a few of the other Dem's and a few independents...
Having said that, let me continue to say that any Dem will lose if they persist in taking away the healthcare coverage from people who happen to like their current (if "politically incorrect") employer or private insurance.
There is plenty of need for coverage so it is in no way incorrect to first expand coverage with a single-payer or public option system. Later,,if ever...either people will decide to drop their employer pr private coverage to save money or net out a higher salary...but maybe not.
Since I'm sure that most/all of the potential candidates enjoy their lavish government or private coverage, maybe they can understand that taking away something that a person likes while asking them to vote for you is a stupid idea!
3
The Democrats are showing us how they can snatch defeat out of the Jaws of Victory. Their dedication to Defeat is enough to make me wonder if the Deep State really does exist.
1
Yes, let them bicker after someone new wins the election. Anyone.
1
The Democratic Party -- to Trump's delight -- has no leadership and no consistent, unified party platform. This health insurance issue, as one example, could so easily be put to bed (since we already have Medicare and Medicaid) by simply opening to the public at large the health insurance program already available to Federal employees. It is managed by the same underwriters that manage similar programs for our larger corporations and their employees. It could be coupled with a negotiated price list for pharmaceuticals covered (as elsewhere in this world.) It could alllow full deduction of premiums paid from taxable income on the 1040 form. Instead we have chaotic and pointless squabbling by second rate candidates.
8
Bernie's Medicare for All plan is the only one that makes economic sense to me. Tinkering with the ACA (more government subsidies) or a public option would be nowhere near as effective. You (Paul) are not helping by disparaging Bernie.
1
@Charles pack Krugman did not disparage Bernie. He made observations on his perception of certain facts. That is an invitation to discourse, not disparagement. And it is a fact that getting rid of private health insurance is not supported by the majority of Americans.
3
@knewmanNobody loves their insurance companies. They needlessly fear losing access to their doctors. People like Paul could/should help people understand the opportunity of MFA rather than reinforcing their baseless fears.
Reading the comments, it's clear that many people are confused about the different types of single payer health coverage. A few points that may help:
First, the American Medicare system is not a typical single-payer system as it (1) leaves too much for patients to pay out of pocket (therefore requiring supplemental coverage) and (2) does not always reimburse health care providers sufficiently. If the US goes to single payer, it shouldn't simply adopt Medicare as Medicare now works.
Second, in single payer systems health care can be provided by government-run care givers or by privately-owned (for-profit or not-for-profit) care givers. In the UK system the government is in the business of providing healthcare (hiring the doctors and running the hospitals and clinics). In the Canadian system, healthcare is provided by the private sector (some for-profit, some not-for-profit) and the government pays the bills.
Third, the role of private providers outside the government system can vary. In the UK there are private providers that provide services that duplicate some of what the government provides and you can purchase private insurance to cover the cost of those duplicative private services. In Canada, it is illegal for private providers to privately "sell" what the government covers (this prevents a two-tier system from developing). But private providers can supplement what the government provides by selling additional services not covered by the government plan.
5
In Canada the government runs the hospitals and pays the doctors. The governments , in our case, are the provincial ones, which run Medicare, decide on coverage, and negotiate pay scales and hospital finances. Hello Mr. Krugman. Why is it so hard to find out what is going on just over the northern border?
Hospitalization, ie , no bills for hospital fees , preceded doctors’ fees when it all began in the late 50’s in Saskatchewan. It has been wonderful.
5
Yep, it hard for famous economist like Krugman to admit that the continued corporate rape of the health system is not bad for the country. That is understandable. But, Sanders is saying to keep any of the private insurers along with Medicare for all will jepardize MCA. How? First of all it will start a competition and continue to keep costs high due to duplicated administration. Yes taxes may have to be increased but they should be increased on super rich. Krugman's analysis of "independent estimates" regarding revenue is suspect due to the fact that countries with universal health have half the health care costs and better out comes. Why is our country that different. Any way, no one has said any of the health care plans would be self sustaining. I got news for you guys, old age, illness is economic loser and until we invent immortality it will stay that way!
2
Looking at some non-profits in the health care industry can be somewhat startling. Take, for instance, the head of Sutter Health in 2015, Mr. Fry, he received over $13.4 million in compensation (of that only $116,532 was listed as salary) according to company tax filings. Every time a patient stayed over night, he earned $6.88 for each night of the stay. And he was not the highest (the head of Ascension Health Alliance earned more). Now, Mr. Fry is not in the Sackler’s range; but then again, he wasn’t dealing drugs, or responsible for a lot of the opioid crisis.
5
"G.O.P. candidates consistently lie about their own proposals". And what proposals have they made? Where is the Trump/G.O.P. plan?
5
I fail to hear any mention from the "medicare for all" crowd, something which any one presently on Medicare knows well, that Medicare doesn't cover everything, that in fact one needs supplementary insurance to make sure one is covered for even some basic services. If Medicare is for all, then are there any limits on what health services one can get? Who decides this? A group of doctors? Government? The larger question is how that will all of this be paid for? Given this I will support a candidate who has given some thought to a phased in plan, i.e. extended basic care but also widening coverage at lower costs.
10
@anselm: Triage is the most difficult ethical issue to negotiate in the practice of medicine. How does one allocate a limited resource to maximize its benefits?
I don't think a public health plan can afford to pay for things like in-utero surgery to remedy spina bifeda, but some will demand it.
It would be great to have real policy debates between the candidates without them (or their supporters) demeaning each others’ character. That is one part of the Trump playbook we can live without.
Every one of the candidates has a record of good work. They disagree on policy and but none want to go back to preObama practice on healthcare. Let’s hear them out and decide without the ugliness, please.
6
If the Democratic nominee runs on a platform of eliminating private health insurance for people who have it through their employers or are willing to keep paying out of pocket for it, s/he will lose the election.
I support single-payer healthcare in time, when the electorate is ready. For now, we have to take it in steps.
The only way to convince people with employer-based health insurance that a government plan will be better is to put it in place for people who currently don’t have insurance, and let people see that it works and it’s cheaper.
I fear the Dems are going to lose the election because they can’t understand that people could feel threatened by such a big change to their healthcare.
13
Paul Krugman correctly points out that there are many ways to achieve universal health care and that a “single payer” system is actually the exception and not the rule, as many Americans seem to assume. What they neglect to point out about the many permutations of health insurance systems around the world is that the private health insurance companies are largely nonprofit. This detail, often overlooked in discussions of this topic, is why “Medicare for All” may be the only practical solution for achieving universal coverage in America, even if it is not the optimal one.
Given the enormous size of our private for-profit health insurance sector, and the overwhelming influence of money in our political system, the chances that insurance companies could be forced into nonprofit status are extremely remote. This leaves us with some sort of single-payer as the only viable option if we are to truly achieve universal coverage.
2
Beyond the fact that it simply isn’t true that all these insurers are non-profit, you may wish to find out what the term means. In most states, for example, Blue Cross is a non-profit.
2
The key fix needed in our inefficient health care "system" (if that's you want to call it) is not about the prices (premiums, co-pays, etc) that we pay but about lowering the costs of providing services. So that means hard negotiating of prices with drug companies, forgiving education debt of medical professionals, removing profit making insurance companies that now are a barrier between patients and their doctors, restricting executive salaries of so-called non-profit hospital administrators, etc. Until those costs are reduced to levels closer to the rest of the developed world, we will continue to stumble along as we are now. Unfortunately, given the permissions granted to corporations in the Citizens United decision, that is all very unlikely to happen. So Joe, Bernie and the rest (including you too Donald) be careful what you promise us if you can't make that happen.
1
I am undecided on this question, but I think you made a pretty good case for Biden.
5
I read often about the “wonderful “ health care in the UK, Canada, etc It’s fine if you never need a procedure and are healthy But there are long waits for procedures that we take for granted here And for the elderly the government decides if an operation is sanctioned or in many cases rejected Follow the money There’s a reason that people with means come here from all these other countries to pay out of pocket for surgeries and cancer care We have the best doctors and hospitals in the world, albeit the most expensive
2
If, as you say, we have the best doctors and hospitals in the world, why do we have the most expensive healthcare, with poorer care outcomes, than countries with universal healthcare?
6
@Ron Duvall
That is not true. We actually have the best outcomes for breast cancer prostate cancer and many other kinds of cancers like melanoma. In cancer, and I am a survivor, speed is at the essence. With private insurance here I saw for specialists in 24 hours into cities which could not happen in any other country but the United States of America.
@Ron Duvall
We do not have poorer outcomes! Why do Canadians come here for treatment? Why do people from all over the world fly to Rochester MN for the Mayo Clinic? Or to NYC for the many top notch hospitals there?
To me the biggest problem with the Sanders plan is one of practicality. It took 50 years to get from Medicare to the ACA. The ACA has accomplished a great deal although it has some problems. It seems way simpler to me to to fix the ACA incrementally than to tear it down and start from scratch. The Sanders plan will take (likely many) years to work out. If corporate greed is a major problem with the current health care system (which I thinks it is) that problem can be remedied separate from the overarching plan.
3
Mr. Krugman,
I'm a bit confused about you mean as "single-payer". You say that the in the United Kingdom, there is single-payer healthcare. You also that that 180 million Americans would need to give up their private health insurance in a single-payer situation. I live in the UK and have private health insurance through my employer. I can use the NHS if need be, but nearly all of my healthcare comes form private providers that are covered by insurance (and I've never seen my NHS GP). That said, if I lose my job or my private insurance doesn't cover something, I can use the NHS. For this reason, I don't understand why if the US followed the UK model, Americans would have to give up their private health insurance? (though presumably such private insurance policies would be altered) Or why you present it as such a strong either / or choice?
21
Because Sanders did.
And I wouldn’t define the NHS as single-payer in Sanders’ sense at all.
@aw It is because of foolish ideologues on the left, beginning with Senator Sanders. They believe so strongly in the ideal of free health care for all that they are unwilling to compromise.
1
During the 2018 election, WKTV in Utica NY ran ads that warned seniors that Medicare for all would destroy Medicare as they know and love it. I don't think that has to be true, but it represents an effective argument against the idea of Medicare for all.
President Obama was dissed for a big lie when he said that, if you like your insurance, you can keep it. In fact, that was the intent of ACA.
Republicans have been very effective when it comes to distorting perceptions of that law. I blame the pundits who ran that debate among Democrats for asking for a show of hands on the question of who would abolish private insurance. Too bad it's more complicated than that.
I also blame the candidates for falling for the trick question. If they had been quicker they would have been silent in protest.
No matter what any individual thinks about access to healthcare, including the president, there is a long process to get to changes that will serve the public good. I'd like to see the candidates and the press address that process.
6
@Betsy S
i think he said if you like your doctor you can keep your doctor. that turned out to have some exceptions. i wish obama hadn’t made that mistake (though i don’t think he made very many).
Democrats, including Paul Krugman, can't hope to have a debate on healthcare unless they drop the misleading terms. First, Medicare is not single payer. It is a three payer health plan. Medicare pays 80%. The patient is responsible for 20%. Most retirees cannot pay for expensive procedures out of sayings. So they elect to purchase private insurance to cover their medical expenses not covered by Medicare.
Many treatments and procedures are not covered or have limited coverage. Some coverage gaps (most dental, hearing aids and eyeglasses), affect a large number of patients and are well understood by patients and voters. Other gaps affect only smaller numbers of patients and are not well known. These include limits on hospital stays after surgery, exclusions of specific treatments and exclusions of specific drugs. A good case can be made that regulatory capture of the Medicare bureaucracy by insurance companies and others in the healthcare industry has produced many of the coverage gaps.
Reasoned honest debate over the role of insurance in healthcare cannot be held on a stage, among ten candidates all hoping to distinguish themselves with a soundbite good enough to go viral.
11
Sigh. Medicare is a single-payer system because one org—the government—collects the premiums and pays the private oroviders. The supplemental insurance is, well, supplemental.
My brother is about to go on Medicare and my husband is on it. Everyone believes it’s single payer but that isn’t quite true. Unless you get supplemental insurance—private insurance, whether through AARP, Highmark, etc—you have to pay various costs and they can get pretty steep. Medicare as is doesn’t include a drug plan or vision or dental. Sure, the left says, make it cover all at little cost and cover everyone.
How? With the consolidation of the health care industry—insurance companies buying pharma chains, hospitals, and physician networks—the concentrated power is terrifying. All those doctors who don’t want to make less, all those administrators who aren’t going to give up their perks, all those greedy shareholders who aren’t about to give up their dividends! Not to mention people who have good insurance, and there still are some, unwilling to take a chance on change.
Let’s face it. We are not Canadians or Europeans. Their systems were put into place after WWII when life was very different, before corporations controlled everything. These issues are so complex and the simplicity of answers I see in so many comments from the left (and I am a life long liberal!) are infuriating. Single payer single payer—as if it were a spell and with the wave of hands will magically work.
8
@map
It won’t be easy for the reasons you say, but that’s also why it is so necessary to do!
3
It’s not a magic spell, but things have got to change.
All the arguments for universal health care run by our government fail to mention that in all the countries mentioned as models have long wait times to see doctors. Also, those who can afford it have private insurance or pay out of pocket.
As for me, I don’t have a lot of faith in another huge government run program. My experience with Medicare in NYC is fair at best.
3
@HPS, I have the opposite experience with Medicare. I love it, and I don't experience any wait times. Often I can see my doctor within days.
I think you're mischaracterizing the experience of other countries with single-payer systems. Canadians overwhelmingly prefer their system to ours, and they don't have longer wait times. That said, I prefer a public option to a radical remake of our health care system over four years. The end result will be that private insurance can't compete with Medicare, and we'll have single-payer within a few years. But people don't want to be forced off their insurance.
8
@SandraH., I too, love medicare and have no shortage of doctors here in SLC. I have the additional coverage and haven't paid a dime since.
1
@HPS
Do you have non-partisan, scholarly sources that document longer wait times?!
In any case, I’d gladly accept longer wait times if it meant everyone was covered!
1
Ask a simple question. Why is the current health insurance system broken? The answer is that private for profit health insurance is not a workable business model without passing enormous rate increases each year. The vast majority of Americans can not afford the premiums, and it will only get worse. Private health insurance as a business is not sustainable. Take a look at a typical hospital bill to see why the collusion between providers and insurance companies to charge these enormous fees will ultimately run out of customers who can pay the premiums. This includes employer supported plans. The fact is Medicare works and Bernie has the right idea. The ACA is vulnerable only because private insurers were left in the mix in the first place.
8
The goal should be universal care. Medicare Advantage, where the government pays premiums to insurance companies to manage the system and the insurance companies can up sell additional coverage if people want it, is a good model that we successfully deploy now and it is growing faster than Medicare, a sign that people like it.
I am personally skeptical that our government has the capability to successfully administer health plans after they were unable to even enroll people in them during the ACA roll out. Offering a plan that leverages the in place infrastructure of our existing system and pushes the responsibility of monitoring and managing fraud to private industry seems like a good way to get to the goal of universal coverage with both government and private plans.
@Ross
The private health insurance industry is the problem — it’s not the solution.
The greedy, for profit, out of control health insurers-hospital racketeers are hardly the ones to be given control over pricing, fraud, etc. Remove government and things will get even worse!
Once again, I'll ask simple questions that no one has been able to answer:
1. In the system of delivering health care from the provider to the patient, what is the role of the health insurance company?
2. How does that company make the process more efficient with better outcomes?
9
If employer based insurance is allowed to be continued, because of the unfortunate Lobby Hobby Supreme Court decision, an escape clause is urgently needed to allow some employees to be able to opt for the public option without financial penalty. As an example, suppose a mother of a son who uses a motor bike for transportation for night shift employment receive a 3 AM phone call that her son received a life threatening injury by a hit and run driver and is need of a blood transfusion, only to learn that her son’s employer is a Johovah Witness believer and has excluded blood product based procedures from the company health plan, or another employee in the same company is undergoing cancer chemotherapy and need platelet infusion to be able to survive the treatment? A non-penalty escape provision to save lives is needed. Better yet, a decoupling of Heath insurance from employment is urgently needed!
5
@Louis A. Carliner Wait. What?
'Indeed, there’s good reason to believe that eliminating the option of retaining private insurance would be an electoral loser.'
I think that this statement needs to be qualified with the detail of what 'the good reason' is?
If a government starts with a blank slate then designing a system which combines single payer and private health insurance is extremely complex but perfectly feasible.
France has such a system. But it is supported by a state of the art, integrated software program that is accessible to all via the internet and is backed up by a truly functioning telephone inquiry option.
However if a government is trying to integrate an existing private insurance system into an existing single payer system then the difficulties in designing such a system are multiplied many times over. This would be exacerbated by unwilling insurance companies. The result can be a disastrous hybrid that satisfies no one.
3
There are so many new faces in the 20 candidates who are so much more electable than the top tier people. Governors and senators that are from red and purple and heartland states. I’m hopefully predicting that Klobuchar gets a second look. She’s sharp and fresh and young and moderate and electable.
4
The real problem with Sanders' "Medicare for All" is that it assumes we can force an entirely new health care system on the US without an interruption of services. The argument that "other countries can do it" ignores a very simple fact - we're not other countries. Our own system evolved to be what it is today, and forcing an instant change will be grossly destructive, with enormous change before American health care could reach a new equilibrium.
The biggest losers will be rural hospitals, and the people who get health care from them. If the Medicare rate were to suddenly become the highest rate paid anywhere in the country, almost (if not every) rural hospital in the country would close. It would take billions upon billions of additional dollars just to keep them open.
Yes, England can do it, but it, like so many other European countries, rebuilt their systems after the massive reset they suffered after a World War. We're talking about rebuilding ours without any such reset. We can either do it gradually or do it destructively. There isn't a good middle.
2
Medicare for all could be incrementally introduced by age group. completely easy to introduce. next straw man?
2
@cindy...and that's exactly what Sanders is proposing.
1
@David: The present US health care system is largely a product of conversion of non-profit hospitals to for-profit hospitals by the Frist family, one of whom became a very influential senator.
I lived and worked in the UK. Private health insurance is provided by some employers as a benefit. This allows the insured to get care more promptly and to see specialists more freely. it supplements the National Health Service. The notion that having a universal single payer program means the elimination of any private health insurance is just not borne out by best international practice. I don't think that outlawing a whole industry which meets demands of many consumers is a smart or politically viable approach to achieving universal care.
1
One reason a European our Canadian system would not work here is that we are not Europeans or Canadians. Americans are more individualistic and impatient (you could substitute "selfish" and "greedy" and I wouldn't argue) and would never stand for the restrictions required to make a single payer system work.
A government-run system would be under enormous pressure to keep taxes low and benefits high. Also, you're putting trust in the government to do a good job, trust most of us don't have, and for good reason.
Keep in mind, also, that the burden of cost reduction necessary to make the system work will fall not just on those greedy doctors and executives and stock holders but on nurses, aides, orderlies, receptionists, ambulance drivers, EMTs, etc.
And then there are the unknowns. Complicated system are built on the expectation that people will act in a certain way. But they don't. Once health care is free, we will consume more of it, much more than the system designers will have planned for. "But that doesn't happen in England!!" See paragraph one.
1
@Ken: I think a Value-Added Tax is the ideal method to raise money for a public health care plan. This reminds everyone of the plan's cost whenever they buy anything. Further, products and services that create additional health care costs can be taxed to recover their extra costs. Public policy should make the costs of health visible and disabuse all of the notion that it is free.
1
@Ken, we already have a single-payer system in the U.S. called Medicare. Americans love it so much that it's become the third rail of American politics.
It's a myth that Americans are more individualistic. People are the same the world over.
We need to evolve toward single-payer through a public option.
2
Expanding ObamaCare is the most expeditious path to some form of universal coverage. Denying private insurance is not going to work short term. However, we must have a more general reform of the system. Healthcare Systems are buying up private practices, pharma giants do not negotiate prices, rural communities are being deprived of adequate services, private carriers of not accountable, these and others are among the other fault lines in this debate. Were the Democrats to, at least, flesh out the problems and clearly define the challenges a consensus, or at least at complete understanding, might lead to viable solutions. Until then, it's just politicians running for office...again.
1
A main reason Canada's system works well is cost control. Hospitals are non-profit and all procedures are done at a set price no matter where or by whom and extra billing is illegal. No matter which system America prefers, until cost is dealt with, and neither of these plans deals with cost, health coverage will continue to drag down growth, well being and individual prosperity!
9
@Bosox rule
Thank you! Finally, a comment that gets to the core problem of cost.
As a political independent, I am not as interested in ideological purity tests as partisans on either side. For this particular election however, for the good of the country, the Trump republicans need to lose.
The winning strategy in health care for this election is to promote the public option. Democrats need to understand that there is a large number of voters that do not trust the government with their healthcare. Many people trust their current insurance over the government at this time, even though they have ridiculously high deductibles and premiums.
Please take inspiration from Ruth Bader Ginsberg and go with an incremental approach. Go with the public option for now, and build on the trust that Medicare has earned. Broaden the trust so that more and more people become comfortable with governmental healthcare. At some point in the not distant future, people will have more personal experience that the government can provide excellent healthcare at a lower cost.
Independents such as myself can get behind the notion of putting a governmental option out there and letting the market decide. If democrats are correct (and I think they are) that single payor is superior it will win out in the market and there will be broad and overwhelming support moving forward. A large number of American voters still need to be convinced of this, and will rebel if democrats try to "take away their healthcare."
18
Instead of listening to two old guys - who have been covered by government-funded health insurance policies for decades - you should talk to doctors about these options. Private insurance premiums allow doctors to treat Medicare and Medicaid patients which pay doctors practically nothing. Will doctors, many of whom have six figure medical school debt, be willing to work for a fraction of their current salary? Will they be able to support office staff and pay insanely high malpractice premiums? What’s the point of insurance if there is no one around to treat you?
2
"...Second, the Sanders plan would require that roughly 180 million Americans give up their current private insurance and replace it with something different. "
This is only partly true.
As of now, Millions of Americans have no insurance coverage. The rest have different plans that range from very poor coverage to gold plated dream plans. Depending on the type of insurance one has today, Medicare for all would have vastly different effects. For the sake of argument, lets say that medicare for all would look like an average or slightly above average insurance plan.
Medicare for all would then be a lot better for those who now have no or bad insurance plans. The average person would receive the same coverage but at a lesser cost while the people with gold standard plans would probably want to retain some form of insurance to cover the luxuries medicare would not cover.
So it's not an either or situation. It's not true all insurance would disappear, and it's not true most people would be hurt by single payer coverage. But this type of disinformation sure muddies the water and make the status quo look appealing while it is a unique disgrace, unique in the world.
6
Simple solution:
Allow private healthcare but no longer allow employers to offer it. This will force everyone (including politicians and corporate CEOs) to access the same options which will create a real marketplace and make it fair and equitable for all. The fact that my company chooses my healthcare makes no sense.
9
Biden and Sanders are fighting over a strengthened Obamacare vs Medicare-for-All. Unfortunately, neither plan fully addresses our healthcare system’s issues. A new plan for health care needs to accomplish at least three important goals: it must provide universal healthcare, reduce its per capita cost which is much more than any other democracy and reduce healthcare’s bureaucracy. While Medicare-for-All does provide universal coverage and Biden’s version of Obamacare comes close, neither plan reduces cost. While the Sanders plan eliminates billing bureaucracy it adds the bureaucracy of controlling the operating budgets and staffing levels of all of the hospitals in the country. The Biden plan adds additional subsidies and his campaign announced that their plan will cost $750 billion over 10 years. Estimates of the cost of the Sanders plan are as high as $3 trillion per year.
To achieve all of the objectives stated above our presidential candidates need to give serious consideration to adapting the German plan to our country. We should consider requiring all employers to provide health insurance as the Germans do coupled with a public option based on Medicare to create the competition that is needed in the insurance market. This approach coupled with our Medicaid, Medicare, VA and Tricare healthcare services would provide universal coverage with the added bonus of reducing Medicaid expenditures since approximately 16% of Medicaid recipients are employed.
3
There is one big difference between our medical system and those of every other country on the planet:
Every American doctor, their spouse, those who would marry one, and those foreign doctors who seek to practice here is the expectation that practicing medicine here is a sure path to money and the good life. The foreign born doctors I dealt with over the past twenty years or so have been businessmen first and medical practitioners second.
Let's talk about that ladies and gentlemen.
8
There is no shortage of dedicated American physicians. That they are well-compensated for knowledge and ability is a good thing that should be true of every job.
3
My brother went into private practice because two different orthopedics groups, in which the full partners each made nearly $2 million per year, dumped him for not referring enough patients for surgery. He was actually penalized for finding effective, low-cost, non-drug treatments for certain patients with chronic pain.
1
One detail worth sharing. The phrase "corporate greed" is often thought to be a codeword for insurance companies. But the real corporate greed is at the hospital level where large corporations swallow up non profits and over time transform health care into a business with little of its original charitable origins. If you read the details of some of the takeover agreements, you find that commitment to charitable care is limited. Good luck to all of us down the road.
8
The sooner the Democratic contenders for POTUS winnow down to a list of the realistic choices of 4, 5 or 6 individuals, the sooner we can get moving ahead on hashing out the real policies and priorities of the likely Democratic candidates.
The current situation of 24 candidates talking past each other over 2 nights is simply a waste of everyone's time and a distraction to the only true goal of making Trump a 1-term POTUS.
The remaining 18-20 would-be POTUS candidates should run for Senate seats in their home states. Do the nation a favor and switch your focus to an area where you might reasonably have some success.
17
There is no way to view Senator Sanders as in any way in the same league as Mr. Biden. The latter has three failed presidential runs, a long history as a bagman for Wall Street, and ( every day, it seems) some sort of apology for a past action or vote.
It’s thanks to Senator Sanders’ honest persistence ( in the face of withering criticism and misinterpretation from the corporate press) in presenting the facts of Medicare for All, that the discussion is on the table in the first place.
We must never underestimate the power of Big Pharma and the health insurance industry to hang on to their profits at the expense of both our health and our pocketbooks.
9
Sanders has been persistent, but hardly honest. He has repeatedly ducked discussion of the impact and cost of his plan — casting skeptics as tools of “corporate greed” and insurance companies.
3
So, while the Democrats are bickering among themselves they all find the time to ask me for money.
Since I have decided that I would vote for any of the Democratic hopefuls over Donald Trump, i find it a waste of money to contribute to any Democratic candidate that, by virtue of their bickering, is helping Trump.
This 20+ candidate primary is taking good money and wasting it - it would be better served being used in the general election.
Trump sits back, laughing, while the candidates give him ammunition: This ones a socialist, this one opposed busing, etc. Let Trump work for his ammunition.
With all the great ideas being floated by the Democrat candidates, the only factor that matters to me is whether they can beat Trump.
Unfortunately, I have no idea.
I'd like to see the 20+ candidates and some experienced Democrat pols (Clinton, Obama, Gore, Etc.) Sit in a room and decide what ticket is most likely to beat Trump.
I know this is not the democratic way, but there is too much at stake here to let amateurs decide the fate of this country - and possibly condemn it to death with 4 more years of Trump.
8
@MS None of us is an amateur at Democracy. Politicians are NOT experts, they simply are afforded the strongest voice! They have made a mess of Democracy to the point that we have a despot in charge of our policy our Treasury, and our foreign affairs! If people had true courage of their convictions, we would look for leaders among those who have actually created a better world in their own sphere of influence, rather than search for one among the minions of corporate money!
@MS
I totally agree. I refuse to donate to any of the current candidates because it is throwing money away and encouraging this destructive competition for the nomination. Will Democrats continue attacking each other when they should be uniting to defeat Trump? We are compromising what should be a given...defeating Trump at the polls. Trump's band of degenerates are certainly united behind his simple messages of racism and greed. Democrats have a better message, but we must unite behind a simple understandable message or all will be lost.
Let’s do some math. There are about 325 million American citizens who all need coverage. There are 180 million on some form of employer sponsored health plan plus more on Medicare/Medicaid. The US spends double what other industrialized countries with national health spend per capita. Employers pay the bulk of insurance premiums through non-taxed employee benefits. There is no additional taxation required to do national health in the US. Redirect the untaxed healthcare spending by corporations, AND provide a discount because we spend so much per capita, and you have national health, a discount, and no uninsured poor people. If this is too hard for American politicians to grasp, then outsource the problem to France which has national health, better service, and spends about half of what we spend. Bonjour and Merci.
12
Perhaps Paul Krugman can also look at the tax portion for Medicare premiums paid by both Employers and employees to fund Medicare-for-All and add that into the equation as far as funding goes for this proposed program. Perhaps Bernie Sanders could look at not taking away personal choice regarding Private Insurance.
What Medicare does right now is to allow you to keep your doctor, takes care of pre-existing conditions and is portable from job to job. Employers and employees combined pay for this. In addition the Cap should be raise from $132,900. in income that is subject to the deduction from our paychecks, to no cap on wages. There is no reason to have this arbitrary cap. It would also add huge amounts to the Medicare fund.
Those who prefer Private Insurance should have that option.
Regarding the ACA, I cannot disagree that it could be improved, but you need to jump through too many hoops to qualify.
Medicare is pretty straight forward.
And yes, I agree with Paul Krugman that the Candidates do not have the luxury of fighting at this moment. Leave that for the campaign between Trump and whomever the Democratic Candidate is for President.
3
When you don't earn more than the $132K cap, it's easy to demand it be eliminated so you can spend more of other people's money. Medicare taxes, like Social Security taxes, were sold as sufficient to fund the system; people paying the maximum would cover the cost of their care, and a little more to help defray others' expenses. It was NEVER intended to be a massive transfer of wealth from earners to non-earners. Go ahead, keep trying to balance every funding shortfall on our backs; that's how you get a Trump.
3
No matter what the president would promise, it's up to the Senate to pass the bill. The present no-win debate could be avoided by a candidate who would pledge to find a way to get Congress to deal with it. Obamacare was not the first choice of President Obama and he didn't run on that version. I live in the land of single-payer and it works well but its introduction was possible because the prime minister with a majority parliament has a caucus with party discipline in its voting. In the US, even with a majority in both Houses, the president doesn't control the votes without a lot of compromise, as Biden understands.
4
SANDERS IS A Feisty old guy, whose energy I greatly admire. I get exhausted just listening to him. Sanders knee-jerk ersatz socialism is the Impossible Dream. Ain't gonna happen in the US. Not now! Not ever! Biden's stump speech is based upon supporting Obamacare while maintaining private options. Of course there will have to be major alterations along the way. The hybrid heath care model including government and private insurance can provide adequate coverage and be sustainable, as is demonstrated in places such as Switzerland and the Netherlands, both of which are highly productive and stable. Yes some of Joe's comments are unwarranted. But he's still working with a revised model that is currently in place, succeeding and will be in need of future modification. Yes, Biden doesn't get it perfect. But let's bear in mind his lending his expertise and experience to Obama's administration for 8 years. If Biden pairs up with Warren, they should have a powerful synergy to bring to the highest offices. The US is in great need of intelligent, dedicated leadership. The nation is suffering a great deal of destruction and must be repaired and restored. Biden and Warren can do a good job of clearing away the wreckage and moving the US forward, while restoring our democratic institutions and our faith in government.
2
A platform that includes a public option is the way to go in order to win the election. I'm in my late sixties, having been Medicare eligible for several years, and I would never go back. Many of my friends are approaching eligibility now, and are elated for that. The thing is, none of this will come about unless Democrats control both houses of congress. Trump is pushing Democrats into a corner, making them take shots at the various alternatives to the grossly inefficient, wasteful, and therefore utterly indefensible current US healthcare system. Agree on a public option, outline the funding costs involved and benefits to be had, and make the GOP own the current system. And then win.
5
I am surprised to see this discussion private or public health care. You can have as a base a public health care which works for everybody. Then as in many countries in Europe, Sweden, England, France etc. you can have an additional private insurance by your employer to give you access to private caregivers. The private is usually for simple straight forward surgeries like cholecystectomies, hip replacements, hernia repairs and the reason for the employer to pay this extra insurance is to get the employee as quick as possible back to work.
1
My personal choice for the nomination is Warren so far, but on this issue I disagree with her and Sanders, and believe Biden's position is significantly better to campaign on. Neither one of these plans is likely to get through the Senate in the next cycle, so it makes sense to run on the one which is more tenable politically. Biden's defense of the ACA and all the work and effort that's gone into it is compelling - why would we Democrats run on getting rid of the ACA - the same position Republicans were eviscerated for in 2018? Harris seems to realize this and has backtracked a bit. In a perfect world, I'd go with Warren and Sanders and Medicare For All - but right now, in this red alert, must-win situation we are giving Republicans an easy target.
3
There are several reason that giving people the choice between public and private health care will not work
The 1st one is obvious. It is much, much cheaper to administer a program where everyone is treated the same than one that has Medicare, Medicaid, VA, Indian health, TriCare, etc, AND 1,500 different private insurance policies (not counting Part D Medicare). Not only is there vastly higher overhead for the private insurers, but the compliance costs for physicians, hospitals, & patients are enormous, at least $600 Billion every year. Choice leaves that on the table.
The 2nd one is that a public option has to cover everybody the same while private plans can develop plans that cater to the young, the healthy, & the wealthy. They can give bribes to companies to get them to buy their coverage, This would leave the old, the sick, & the poor to the public option or Medicare itself. All this would raise the cost of the public option & negate any administrative savings.
The 3rd reason is that the universal gov run plan of other countries ALL have one entity that can gather data, analyze it, & make recommendations based on medicine, not profit. If a lot of people are covered by private companies which keep their data secret, we could not do this. See https://www.nytimes.com/interactive/2014/health/paying-till-it-hurts.html
We can look next door to see how efficient MfA would be. In 2017, Canada spent $4,753 in PPP dollars per person for health care. We spent $9,892.
10
I'd like to hear the position on fixing Medicare fraud from the advocates of Medicare for all. Medicare is getting milked by lowlife scammers, and if it is all there is, that needs to be stopped.
1
Krugman is back to 2016, behaving badly
Are you reminded of his constant attacks on Sanders, culminating in
"Sanders over the Edge" ?
I am
5
Thank you for this reasonable opinion piece which seems to have a goal of informing voters about the differences and is a warning about the circular firing squad.
Wouldn't it be grand to hear our candidates encourage and support one another? Something like, "Everyone on this stage wants all Americans to have access to good healthcare and eliminate the medical bankruptcies that devastate so many families. There are many different roads to this goal, and there are pluses and minuses to each. I have my favorite plan and details are available on my website if you are interested. In the meantime. please know that each of these Democratic candidates want to make sure that each person in the US has access to good health care. Please know that, despite promises to the contrary, the other party is not committed to assuring either access to care or elimination of medical bankruptcies. "
Wouldn't it be great to just hear candidates affirm each other? And speak reasonably?
Remember that little comment McCain made affirming Obama at his rally? Has any other comment by a politician in recent memory been mentioned in honor so often?
It's the way to go, candidates.
10
Kept waiting for how Bernie is behaving badly. All I see is Biden is lying and fear mongering to old people (at the AARP event) about them losing their Medicare under Bernie's plan (which is not true). Seems like a false equivalency to say they're both behaving badly. Only Biden is deploying right wing fear tactics.
10
What is Sanders plan for actually implementing a single payer plan? There are 2.66 million Americans who work for the health insurance industry. That is roughly 1 in 60 jobs in the entire country.
Seriously, how do those who support a Sanders style single payer plan propose to actually implement it. You are talking about completely destroying and rebuilding 1/6 th of the entire American economy.
I’m a liberal in NYC and can’t honestly say government services are a panacea. Been on the NYC subway this summer with jammed crowded hot cars? Last time you went to the post office, how was the wait? Friendly helpful postal worker behind the counter? Garbage pickup works like clockwork, right?
@Ethan
According to the column Sanders is "broadly hinting that Biden is in the pocket of corporate interests" on the health care issue. I don't know how blatant such hints have been but Bernie sure used that accusation effectively against Hillary Clinton. It is a time-honored rhetorical technique of the left-- if you don't agree with me you must be a tool of corporate interests--that is the bad behavior Krugman is calling out.
1
Indeed, they need to park their egos and lead by speaking the TRUTH.
Don't lie to the American public.
3
Democrats should be so out of breath attacking Trump’s policies that they are unable to criticize each other.
5
For anyone who's ever visited a hospital emergency room, it's obvious that solving our nation's health care crisis needs to start with helping everyone, from young children to senior citizens, lose weight. Why don't any of the candidates talk about this?
1
Possibly because there are many illnesses and injuries that have absolutely nothing to do with a person’s weight. Also, I think the “crisis” has more to do with people having trouble affording their healthcare, even for basic services.
1
@Peter
Why--because we just can't offend anyone---the majority of the people in this country are too thin skinned to handle the truth and too lazy to lose weight.
The swiss model of regulated, subsidised, universal private insurance can work just as well as the canadian single-payer model assuming rational political parties with a genuine interest in maintaining the system. Unfortunately, we don't have that, we have republicans. The complexity of the ACA, its rube goldberg, hundreds of moving parts nature, is easily sabotaged when the party in power is composed of lying lunatics. That, unfortunately, is exactly what we have and we simply cannot place our bets on them changing or going away.
5
Under either proposed system does anyone believe that Bernie, Joe or Paul will be waiting in line to see the Doctor like the rest of us?
If Democrats have to stay far away from anything that's "hard," there's no hope for a better future.
The elephant in the room is 20 years of tax cuts that have made it very difficult to even talk about doing the things we need to do to make this a better country and a better world for everybody. Republicans continue to feed the elephant. It would be bad enough if Democrats were merely ignoring the growing beast, but they're actually enabling the Republicans by playing along with the "How are we going to pay for that?" game, while simultaneously dealing a hand of "People will never go for that."
The Democratic Party old-guard have been enablers, pleasers, and appeasers for too long.
People are looking for a real leader. Cowards can't be leaders and leaders can't be cowards. Time to step up. Or we can just keep running scared and playing defense and trying our best not to upset those center-right voters by being Democrats.
4
I have good private insurance through work - indeed a plan that used to called a Cadillac plan. I hate it and would gladly give it up for a national health plan like the rest of the more advanced world. The USA 🇺🇸 s going right down the tubes with wasting all this incredible amounts of money on nothing more than corporate greed. Instead of paying for health care we are paying for corporate greed. It’s that simple.
8
I donated money to Hillary so she could spend more to shore up support in Pennsylvania Ohio and Michigan. She didn’t spend did not do that. Now, in this election, the Democrats are going to far left. Trump is very unpopular and he can be defeated. if the Democrats lose this election it’s on them for being too foolish and not representing the majority more centrist views on moving the country forward.
3
I am far from a Biden supporter. But his proposal makes absolute sense, and most important of all, it backs a system that -- despite Republican lies and sabotage -- is extremely popular. I suggest we hitch our wagon to the most electorally successful Democratic idea of my lifetime, and not to a plan that plays right into the "Socialist" rhetoric of the right. This is NOT an election for hobby horses. This is an election we absolutely cannot lose.
Oh, yes, and stop arguing, both of you!
4
The article states "... And while Sanders has in fact proposed a number of new taxes, independent estimates say that the revenue they’d generate would fall far short of what his plan would cost."
The "independent estimates" consists of one link to one study by the Urban Institute dated May 2016. A more recent analysis is in an April 2019 New York Times piece comparing five different estimates of the costs of M4A to the cost of continuing with our current healthcare system:
https://www.nytimes.com/interactive/2019/04/10/upshot/medicare-for-all-bernie-sanders-cost-estimates.html
2
Behaving badly does not disqualify them if anything it prepares them to stand up to Trump.
2
Medicare for all. No brainer.
3
Yeah, unfortunately, like anything important gets said in these debates.
In assessing Sanders plan you pointed out it's flaws, both in practice and political. One of the elements of Sanders plan would be the elimination of private insurance. You then refer to that as an "electoral loser" when you mention the plans of Harris and Warren. If it is a loser when part of their plans its also a loser when part of Sander's as well. Biden is trying to keep the Democrats from running on a health plan that is a "loser." I hope he succeeds.
There is no chance that tens of millions of Americans will give up their private health insurance any time soon... And has anyone made a convincing argument why they should.?
... And any effort to force them from their private insurance will be a disaster..
..Therefore, a realistic approach to health care must allow a place for the private insurance many people now get from their employers..
... -- And this is an issue that will be decided by voters..
Bernie Sanders cannot stop himself from lying about the costs in higher taxes of his signature “Medicare for All” proposal. On that issue, Sanders is as habitually dishonest as Donald Trump is about everything.
Joe Biden needs better advisers. There is no need for him to adopt the Republican tactic of claiming that Sanders would “undermine Medicare.” Biden’s seeming dishonesty is simply ignorance of the facts.
This failure to do his homework does not exculpate Joe Biden, but it is quite different than the intentional deception practiced by Sanders.
This column is rearranging the deck chairs on the Titanic.
If either of these two estimable people is nominated, neither of their proposals will come to pass, because the Democrats will lose the Presidency, the Senate and quite possibly the House.
A majority of Americans like their current health care plans. That alone dooms Sanders' bizarre proposal to eliminate it.
Biden has been a punching bag every time he's run for President. Trump cannot begin to stand up to anybody with intelligence, youth, energy and wit. Biden has some intelligence, but fails on the other counts. If he's the nominee, Trump will eat him alive. It doesn't make me happy to write that, but it's true.
One way or another, I have to believe that the Democrats will see that only a candidate who can beat Trump is worth nominating. I am sorry to say that neither Biden nor Sanders qualifies.
Dan Kravitz
Imagine how liberating it would be to be able to make employment decisions without having to worry about the affect on your health insurance. Corporations are certainly aware of this and are worried that they might actually be forced to increase wages and/or improve the work environment to retain employees.
8
I am not a fan of Sanders as I believe the math on virtually everything he proposes is flawed and that each proposal would cost taxpayers much more than he is stating. That said I am not sure ultimately how important it truly is for there to be a private insurance option. If we look at it from the perspective of consumer we all eventually move away from private insurance to Medicare when we retire so we essentially enter into a single payer system. What is not clear to me is how would things be different for a family under single payer versus having a private insurance option.
But I agree with the main premise that either form of providing health care for all can be made to work, we just have to decide it will work.
The one part I cannot get onboard with though is providing such coverage if you are in this country illegally. I am not against immigration, other than the Native Americans we are all descendants of immigrants or are immigrants ourselves. I am against people getting rights when they broke the law to be here. The way Trump is handling illegal immigration is wrong. But there is a difference in disagreeing with the principle and disagreeing with the way it is executed.
1
Krugman praises Biden's proposal as one that is "actually pretty good, and which most people would have considered radical just a few years ago." Bernie Sanders is largely responsible for the shift in the debate and the public's support for a more comprehensive health care reform. Hi tireless advocacy, for a Medicare For All System has raised the bar for all democrats. That's why I support Bernie.
3
Bernie people WAKE-UP! Instantly getting rid of private health insurance will cause a depression. California and Vermont both tried to pass state versions of single payer.
The California bill was scrapped when sensible people, who know how to do math, realized 150,000 Californians work for the health insurance industry and California can’t loose 150,000 jobs overnight without massive financial disruption.
The Swiss, Dutch, German model is most feasible, can accomplish the same universal goals, and allow for innovation going forward. It also aligns with the more capitalist world view of our fellow Americans who are conservative and Republican. It is important that the plan appeals to as many Americans as possible.
2
The current run of GOP Congressional power owes its success to the attempts by Democratic presidents to make health care its first and most important priority. They are licking their chops. I want to hear how the Dems will grow the economy without higher tax rates and how we will deal with China. Then I know we can win. If we can succeed after winning then we can look for long term changes in health care and health insurance.
@Wayne People die while waiting for the economy to grow.
‘Infighting’ is how you lose an election, a tactic the Dems appear to have mastered all on their own without any help from the Republicans.
4
Washington Post headline: “Sanders vows to reject donations from drug and health insurance industry, seeking to pressure Biden”
This is the topic we need to discuss.
Candidates who take the HC industry, Sanders aid, “should explain to the American people why those interests believe their campaigns are a good investment.”
Article says “Biden, in contrast, has some ties to those industries. He has received four-figure donations from executives at companies such as Merck & Co. Inc., Independence Blue Cross and Gilead Sciences, campaign finance records show.”
"Candidates who take such corporate donations dismiss the notion that it makes them beholden to powerful industries, pointing to their record and their platform.
Elizabeth Warren has eschewed big-donor fundraising events.”
On the NYT op ed page this whole topic is neglected. The media in general reports who is raising the most money, but little on where that money comes from. This fosters an attitude of tolerance for legalized political corruption that undermines our democracy. We the People can’t afford to compete.
5
Obamacare was flawed from the start...a give away to the insurance companies. Now it is essentially useless because been gutted and stigmatized. Medicare can easily be expanded and improved. plus the cost can easily be covered by cutting the Pentagon budget and war chest as well as stopping subsidies to big oil, farmers, insurance companies, drug companies and other countries. Biden's past record on all human rights and social programs is horrific. Biden is only in the race because he is the DNC neoliberal puppet selected to support the status quo.
7
What would the definition be of a legal resident? This appears to be glossed over.
Isn't Biden "in the pocket of corporate interests"? This is what I'm finding (from American Prospect):
Steve Ricchetti, Top Biden Campaign Aide, Was a Health-Care Lobbyist
David Daen
July 18, 2019
The vice president’s former chief of staff once represented hospitals and drug companies. Now he is part of a campaign that is attacking Medicare for All.
That could explain a few things, right?
Krugman wrote, "It’s a bad sign that Biden, who poses as Obamacare’s great defender, is using a G.O.P. scare tactic familiar from the utterly dishonest campaign against the A.C.A. No Democrat should be stooping to that level." OK, Paul, but what is it a "sign" of? I would say it's a sign that "Biden is in the pocket of corporate interests". What were you thinking it was a sign of?
4
I can’t really follow one of Krugman’s criticism of Bernie: the idea that any significant proportion of Americans have some form of “attachment” to their insurance companies. I understand insurance companies extract a profit from the process. I don’t, for the life of me, see what they contribute to the process.
In the places where I worked, health insurance providers were swapped out repeatedly as they all raised their premiums to protect (or grow?) their profits. I never heard one yelp of loyalty to any of them.
Is Krugman thinking about the Cadillac policies for the most highly paid and valued supporters of our corporate economy?
I don’t understand.
11
@Joseph F. Panzica. I think it just means people want to keep their private insurance. It doesn’t mean loyalty to Aetna or United Health.
The United Kingdom does NOT have a single payer system Mr. Krugman. They have the government run National Health Service (NHS) and a separate private system. Have you heard of Harley Street in London? As a physician, I have worked in South Africa where I was trained, the UK, Canada and the USA. Canada for the most part has a single payer system-workers compensation is a separate system. Access to care in Canada is problematic with long waiting lists for elective surgical procedures and difficulty accessing advanced imaging, such as MRI. There is no question in my mind that the best system includes a national public health care system that covers everyone and a private system for those who prefer it. The Europeans figured this out a long time ago!
11
One part the debate that few, including Professor Krugman, seldom, if ever, address concerns how a medicare-for-all system might dis-incentivize the "best of the best", or even the mediocre, to become doctors.
In Iceland, where healthcare costs residents a pittance of what it costs in the U.S., there is a dire shortage of doctors and other staff.
For my part, I would return to the U.S. if I came down with any serious medical issue. Ditto, when I lived previously in Germany and Malta. Many others (who can afford it) from those so-called utopic medicare societies have also opted to get treatment in the U.S. for serious medical care.
Why? Because the U.S. healthcare system has arguably produced the supremo doctors in each field. And it would be a shame to lose that!
4
@Concerned American Does it not concern you that while the US system has more excellent doctors (many from other countries BTW), access to those excellent doctors is dependent, for far too many, on their financial werewithal? Were it not for Medicare, I would not have had access to a specialist who fixed my debilitating angina without destroying what is left of my kidneys (he is a Brit of Pakistani descent) and without whom I would be in serious pain for the rest of my shortened life. I have, in retirement, good coverage by a combo of Medicare and Blue Cross (former employer provided) so I may yet see my granddaughter, now 12, graduate from college (I promised her that I would). But I am deeply distressed by the knowledge that many of my Hispanic neighbors (among others) who do not have such benefits, working two or three jobs just to pay the rent, would be unable to access that care which surely many of them will need. is this a great country or what?
7
@jprfrog
Yes, that is concerning.
In the same vein, however, it concerns me that when I lived in the U.S. I could afford to live in a veritable mansion while Hispanics lived across the tracks in far less splendid housing.
At least they had access to the same relatively high public education my children experienced, the kind that my own Hispanic mother went across Manhattan to get from her poor neighborhood in Spanish Harlem.
But, likewise, to get better housing for everyone, I don't think we should eliminate mansions that at least used to be part of the American dream, even if I find them far overrated?
1
@Concerned American
You are assuming that it is our insurance system that creates "supremo" doctors. This is wrong; it's our university system.
Our insurance system is what guarantees that the US has very poor health outcomes when compared to other countries. We are nowhere near the "best of the best."
Private, for profit insurance isn't bringing any excellence to the table.
3
No matter which position you take health care will not win the election. The "man" or "woman" will. By that I mean we have over 20 people running and not one of them has the personality-unless screaming and yelling counts, to capture the hearts of Americans. In short no charisma. Trump has charism- its just bad charism. So, although the health care argument is valid and all people should have it- that issue is meaningless unless we have a great candidate-and right now we just have 20 not so inspiring individuals(plus 2 more in my office who have declared their candidacy-Phil and Staci (yes its with an i not a y- so get it right when writing about her).
2
If you are over 65 and slip and fall injuring yourself while getting out of your car on your way to a business meeting, your medical bills could be paid for by: 1) workers compensation coverage through your employer; 2) your own private health insurer; 3) Medicare; 4) personal injury protection (no fault) on your auto insurance; 5) medical payments on your auto insurance; 6) medical payments coverage from the business premises you are visiting. Premiums of some type are paid for each one of these coverages. Premiums that will go away if there is single payer coverage. By the way, most state’s workers compensation systems already have scheduled costs for medical procedures-you remember workers compensation-the system that was initially found to be unconstitutional because it was brought by the labor movement back in 1910. Workers compensation was the end of capitalism, just like Reagan’s predictions about Medicare/Medicaid. Our system is beyond laughably wasteful right now, and is does a bad job to boot (my daughter’s practitioner just declined to accept my very good employer sponsored insurance CIGNA, claiming her pay is inadequate).
5
@Powderchords
Right. There is room for compromise. One would permit a buy in for Medicare starting at age 55.
Another variation would be to eliminate the collateral source rule in litigation, assuming that people have coverage, thus reducing premiums.
@Powderchords
I've often thought that a proper health insurance system would simply say, "If you need medical treatment, it will be covered." If you didn't have to prove fault and liability, you wouldn't have to sue for pain and suffering, simply to have enough money to pay the medical bills and the lawyer. Properly fund government organizations like Consumer Product Safety Commission and OSHA and have them eliminate hazards.
We have an enormous unproductive infrastructure to prove fault and insure against it that could hopefully be put to a more productive use.
2
The only subject this Congress can agree on is increasing spending next year by $320 billion. Krugman must be in heaven
About 170 million give or take a few million are covered by employer sponsored insurance, another 58 million have Medicare, throw in another 12 with TriCare and that is a lot of satisfied Americans, perhaps perplexed and frustrated, but people with pretty good access
Much better acces in fact than those single payer nations.. They will not accept Medicaid for all, with an expensive out of pocket supplemental plan. Keep in mind all those premiums are income tax free, a supplemental plan would be after tax dollars
What is clear with Obamacare is that the individual market doesn’t work. It doesn’t work in any other form of insurance risk vs. claims paid.
1
@hawk
1. It's systematically Democrats who lower deficits, when they control DC, and Republicans who increase it (under Trump, the GOP even doubled it, and with one single bill: their tax cuts for the wealthiest).
2. "Passing a budget" concretely means that Congress accepts to pay a certain amount of money to the Executive branch of government (= the White House) in order to allow it to implementing already existing law correctly and competently.
One of the things that the White House HAS to do, is to pay interests on the federal debt (which constantly increase as the debt increases, and the debt increases ONLY because the GOP refuses to lower and then eliminate the deficit, but instead doubles it, when passing new bills), and of course to implement existing law.
That means that EACH time Republicans pass a new bill and don't include a way to pay for it (eg raising additional revenue or cutting other spending), the budget that the next Congresses will have to pass as the next Presidents HAVE to implement those laws too, will systematically increase.
So what's crucial to understand here is that those $320 billion are NOT "new spending". These are just to pay for bills that have ALREADY been signed into law.
That's also why a government shutdown makes no sense at all, as it means not giving the WH those means in time, even though it will HAVE to use this money to do its job. And without having the money in time, the WH simply has to pay additional fees, interests etc
3
@hawk
I have lived in Canada, England, Belgium, and Germany all have far superior access to care and treatment even at the higher end of the economic ladder. A suspicious mole was found and I was told that it would take 6 months to see an in network specialist, I had a top rated insurance plan. I started calling and the best emergency appointment I could get was 4 months in a major metro area. I went back to Canada and was seen in 2 days. The cost $10.
The US system works for the top 5% and those lucky enough not to get injured or sick. The other 95% would see a huge improvement if the US would enact a European health plan.
8
@Ana Luisa Revenue into the US Treasury is at an all time high. About 11,000 Baby Boomers become eligible for Social Security and Medicare everyday. The peak year for them is 1958, four years away, and therein lies the problem with deficits. It is not a Republican or Democrat problem, it is people in DC that refuse to face reality. Paul Ryan was vilified 10 years ago,
There are two issues regarding proposed healthcare coverage which are not being discussed. Should we adopt a Medicare For All system, employers will no longer subsidize employee coverage. As it is, though an employee may be adequately covered under a company plan, the premiums for family coverage are exorbitantly crippling. More importantly, this would be a windfall for corporations to no longer subsidize healthcare. Where would these savings go? Would this lead to an increase in the obscene compensation of the 1%? Another concern is the elimination of the penalty for those who choose not to be covered. It has been my experience that people always find money for something they really want but claim not to have it for premiums under the ACA. Yet, family members and others I know make regular use of emergency rooms for cuts, falls, colds, etc. Yes they get billed by hospitals but ignore the bills. Since they are a debit card, rather than credit card nation, they do not care about a FICO score. Hence, premiums go up for the insured.
3
Thanks for this great column, Biden has a winning argument on the taxes alone. No need for hyperbole.
2
There's a third way, which makes the most sense. Canada.
Canada has a universal health care system that’s paid for through income taxes and sales tax. All Canadians are covered, and they can see any doctor they want anywhere in the country with no copays or deductibles….And while the individual provinces and territories set their overall health budgets and administer the health plans, the delivery of medical care is private. Doctors run their own businesses and then bill the government.
Canadians can purchase supplemental private coverage for services that are not covered by the public plan, but cannot purchase private insurance for basic services. As CBC News points out, private health insurance is “a crucial part of the system,” and Canadians spent about $43.2 billion on private coverage in 2005.
So, for basic services, you MUST use the public plan.
13
Before Medicare there were two classes of medical care: What people paid for with cash or insurance which was pretty much upper middle class and higher and what people got as charity from doctors and hospitals. Ward care in a big room with twenty other patients was standard. Unnecessary surgery (now half of it is) was not done on ward services. Why? in a charity ward. Medicare changed all that. All of a sudden ward cases got semi private rooms. Doctors got paid for surgeries they never were paid for before and they began to milk it. Government pressure moved private and ward care together and funded it. It is not going to change. We need to take the profit and money out of medicine and go the whole way......insurance companies do need to vanish. The billing pandemonium needs to go away. Bernie is right. If we do not demonetize medical care things will only get worse.
7
Biden, Sanders or any other Democratic candidate have much more chance to get elected with Biden's plan. It could be a transition or not.
But telling every American who work for corporations and, who have health insurance as part of their benefits, that it will be taken away, is not only unfair, it is guaranteeing Trump's re-election.
I was part of that group of Americans for a long time and, even Hillary would have lost my vote if she had proposed to take away my private insurance. Not that it would have mattered. Anyway.
3
Though I'm a realist that Biden's plan will win more support, it's disheartening that individuals are far more concerned about themselves than what is good for society.
I would gladly vote for either Biden's plan or single payer over Trump's destructive policies (Paris agreement, tax cut to the 1%, alienating our allies).
2
The Trump Wall st White House Administration has been and even now is placing multiple industries leaders in government positions to gain insider information for financial gain. It isn't just an effort to deregulate industries. It's a strategy to enrich them. the F.B.I. should investigate all administration and Congressional Republicans under the R.I.C.O. statute.
Mueller can begin by serving the American public tomorrow instead of the "Barr".
4
More and more, I'm starting to think that the Belgian system might be the best solution for the US too.
It's not exactly single payer, as it's not the government but a handful of non profits that pay doctors, and citizens are free to pick their own non profit and buy insurance there - although there is an individual mandate, so you do HAVE to become a "member" of one of those non profits.
Those non profits then negotiate reimbursements, premiums and out of pocket costs together with patient and doctors' organizations, hospitals, AND the government. The result is that most non profits offer very similar insurance plans, with only slight differences.
The big advantage, however, is that on the one hand people have some sense of control over their health insurance, because first of all, they decide which non profit they'll become a member of, and secondly, they elect the government and as a consequence the politicians who represent their own preferences about insurance plans. On the other hand, however, as it's NOT the government itself that pays, people don't have the impression that it's some kind of huge bureaucracy that decides, or a bunch of "corrupt" politicians etc. In his way, healthcare gets MUCH less politicized than in the US.
At the same time, those non profits precisely define themselves by their "political color", so one is "Christian", one "Socialist" etc.
In the US that would mean that the GOP offers its own insurance plans, and Democrats theirs ...
4
It's long past the time that we join the rest of the civilized world and adopt "universal, single payer" as our model for health care coverage. Health care should be considered a "basic right" for all citizens.
9
The GOP has a great plan for deciding on our healthcare system. First they amp up the grievances against the current system, and then the people will vote for anything else, even if it’s worse. Biden and Sanders should try that approach.
1
I think people are seeing Medicare for All through rose-colored glasses. Medicare is not simple. On the other side, those who fearmonger about systemic revolution or job loss if private insurers disappear should realize that Medicare is full of private insurance.
Today, if a Medicare recipient opts for Medicare Advantage, which is basically a Medicare HMO, a private insurer will provide it. Alternatively, Traditional Medicare users also buy Medicare supplemental plans for non-hospital (part B) coverage, also provided by private insurers. And then there's Medicare Part D, the drug plan, which is administered by private insurers.
I think it would be best to concentrate on the goal--universal coverage--and then think of how to get there from here. Building on the ACA with a public option would be a great start. And bring back more viable exchanges by getting rid of the Rubio amendment rule that said they could not run in the red from the get-go (a higher standard than for, say, Amazon, or the federal government).
Key to keeping universal coverage affordable is containing costs, and that will best be accomplished with the bargaining power that a large-scale government-sponsored system can provide.
6
@midwesterner
Correction: Rubio amendment affected cooperatives, not the exchanges.
There are almost two dozen of them bringing down the party's chances day by day with their characteristic self destruction. Still, they don't recognize the secret of Republican success; rigid unity of message. I read the wonderful obituary about the passing of NASA's historic leader, Chris Kraft. He essentially summarized the universal strategies of engineering staffs and inventors. To get to a working model of maximum utility and efficiency, you must build a constantly improving design through prototyping as long as it takes to get to that first Car or the first computer. Thomas Edison famously made many dozens of prototype light bulbs until he finally made a carbon coated filament in a vacuum bulb that finally glowed without flaming out. The Democrats are victims of the Republican cynical name calling over decades and have devolved from a unified truly caring party to one infighting understandably in the current horrible humorless Republican environment. They must huddle, face the fact that only a unified field of candidates can gather to win as a force for good against evil. Build on Obamacare. This nation is not ready for the shock of Medicare for all even I wanted. I'm practical. Get to ideal by prototyping. And tell the Republican voters not to vote against their own well being.
9
The problem with the British system is that while it provides the same service for everyone, free at the point of use, the service itself is poor compared with many other systems.
Find yourself in a road accident, have a heart attack, and you’re going to get excellent treatment. Cancer, and chronic but not necessarily fatal conditions, not so well.
And getting a quick appointment with your local frontline doctor is often impossible.
1
@Iain Clark
I think that we have to be realistic here: in most Western countries, it takes about 2-3 months before you can get an appointment with a doctor, or non urgent, chronic diseases.
That's because here simply aren't enough doctors, not because of one or the other flaw in the health insurance system.
Yes, in the US a handful of wealthy people can get access to their doctor faster, even in non urgent circumstances. But that's because they can pay more. And that's exactly what creates an unequal and unfair healthcare system, once you define accessibility to a doctor by how much you are willing/able to pay him, rather than by the mere fact that you're ill and as a consequence deserve to see a doctor ...
5
I was referring to your local doctor. Specialists take longer.
If you have a chest infection and can’t get seen for 3 months then you’re either better or dead.
I live in the US and have excellent, expensive insurance through my work for a 20 billion per year Corp. It takes me 2-3months to get an appointment with my doctor for non-emergencies. I can see a nurse practitioner quickly though it's likely to be a different one each time. the wait time argument is acted herring
5
What is really disingenuous in the discussion of Medicare for All proposal's political discourse among the pundits (looking at you Mr. Krugman) is the fact that 60 % of US employees are enrolled in "self funded" or "self insured" employer plans. Why aren't CEO's, Unions and workers not talking about how costs across the board will diminish with single payer? Business would benefit by having a known tax rate/employee instead of unforeseen costs should some of their insured develop a high cost illness. The employee may have a larger payroll deduction, but no longer has large deductibles to satisfy (which tends to put off cost saving primary care). Job mobility expands since an employee is no longer tied to a particular employer for fear of loosing coverage. Remains to be seen if employers, once no longer saddled with budget restraints for providing the cash necessary for self funded plans, will share the increase in profits with the employees. In the USA, you already have a single payer system that resembles ours in France: a single payer (Medicare) and private insurers that pay the co-pays (MediGap). Affordability of the MediGap plans also implies government oversight, especially for those who would purchase those policies on their own as opposed to corporations who offer the policy in their menu of benefits. Hidden in the cacophony in the debate in the USA is the $ interests of the health care system: insurers, pharma, for profit hospitals, claims administers, PBMs... sad
13
@jmc Thank you for this. My thoughts exactly. To put it differently, the larger the risk pool, the cheaper the insurance. The largest risk pool is the entire US population. Some form of single payer is the largest risk pool and should therefore be the lowest cost.
Alternatively, I do like the Belgium idea as mention by @Ana Luisa in these comments for two reasons. For one, it still gives choice and, two, it takes the profit motive out of the insurance equation. For-profit companies have exactly one fiduciary responsibility and that is to manage their expenses in order to maximize profit for their shareholders, not to their customers. By taking profit out of the equation, the fiduciary responsibility can be placed where it should be, helping to ensure the best outcomes for their customers.
4
You don’t have to raise taxes for single payer. Just cut the Pentagon’s budget.
19
@KxS. And then we can rely on Canada for our defense, maintenance of freedom of navigation around the world, and so on.
The problem is (and corroborated by many) that the medical profession charges altogether too much. And in looking over most of my medicare expenditures that are sent to me after the fact, is that many small maladies are over exaggerated. So we are spending far far too much on medical visits as well as hospital expenses. Medicare does try to limit these with only moderate success. Living in a rural county also has its problems. A County Health officer demands a guaranteed income of $600,ooo per year? Yes and it is TOO MUCH.
7
In fact, as Krugman admits himself here that for the moment, Sanders didn't come up with a plan to truly fund Medicare for all yet, shouldn't we say that Biden has a point when he claims that Sanders' plan would undermine Medicare?
2
Americans like to have options and to feel they're in control of the choice of which of those options they choose. Give them several health care options. All high quality. That's the way you win elections.
3
But there are problems for a state healthcare system caused by private health care provision, and the thing is to make a state health system so good that private provision is unnecessary. It's important to prevent creeping privatization (or 'public private initiatives' as they are called in the UK) is and keep private providers at a distance as they usually rip off the government, and monopoly purchasing of drugs can help keep prices down and prevent exploitative profits of the drug companies. A private health sector can divert resources away from the public health sector, such as scarce medical staff and increase costs. Most people don't resent paying higher taxes if its clear they are intended for a public benefit, especially health care, at least that's the European experience.
4
@Tom - I agree and although Australia has a universal Medicare system (not a NHS), with a progressive tax-type labelled payment, the right wing governments have allowed, pushed for, private health insurance [even BUPA, one of yours has invaded here, badly too] to white ant Medicare. Also they send patients to public hospitals when they can't be bothered to provide care. Young healthy people are dropping out of private insurance, so it's near collapse. The latter naturally want the abolition of Medicare! Controlling these private ones is terribly difficult too and profits are sent to tax havens. Krugman needs to understand that if reversing private health is hard to implement in America, the consequences of not trying are also ghastly.
5
@Hector I wouldn't tar all private health insurance companies here in Oz with the one brush. In defence of Bupa, I have had nothing but good experiences in using their services - services I would not have been able to access quickly in the public system.
I am not obese, overweight and watch my diet reasonably, yet in a high-stress job I had some heart "events" in the past seven years. I have been well looked after and paid a minimal amount in terms of medical services, albeit I have had private health insurance for more than 30 years. Bupa also assigned a coach to work with me on lifestyle issues weekly for a period of six weeks, at no cost to me, after my heart bypass operation in 2012. I have not been a strain on the public health system, although as a taxpayer I have contributed my share of the Medicare levy as long as it has existed.
From my point of view, thank god I had private health insurance.
@Tom, @Hector With governments, right-wing, centrist or left-wing intent on cutting funding to the public health system I am not sure we will ever achieve "a state health system so good that private provision is unnecessary". Not in my lifetime, at least.
This seems so obvious to me...'Medicare for All' sounds scary, 'Medicare as an OPTION for all' sounds like a winner.
11
@jomiga Agree - Medicare for All THAT WANT IT! I've long believed we should carve "essential" care i.e, catastrophic, critical, chronic and preventative care, and cover everyone (including authorized... "Visaed"... visitors; unauthorized people would be eligible only for catastrophic and preventative care once, then deported). Private insurance could be purchased (and subsidized for those under FPL and exceed 8.5% of income + liquid assets accompanied) w/ true price transparency and coverage regulation to better ensure efficient utilization and level the playing field (which would include a Medicare4All public option).
Problem is: How the heck to fit that on a bumper sticker LOL?
I agree that the Dems should debate the merits and demerits of both proposals, not demagogue and give the GOP talking points.
At the same time, I think that both sides should acknowledge that no proposals will become law. Look at the ACA, which had to become a Frankenstein’s monster, without a single-payer option.
Understanding this, as well as the fact that the inevitable disinformation campaign, using bumper sticker slogans (e.g., “no collusion, no obstruction” about the Mueller report) that will gaslight much of the electorate into believing both plans will turn us into Venezuela. As Trump so aptly put it, “Who knew healthcare could be so complicated?”.
By having a debate that describes aspirations rather than nonnegotiable specific plans, Democrats would show they are trying to do what the American people want, in contrast to the Republicans who lost in 2018 precisely because they threatened the healthcare of millions.
Healthcare is complicated, but it should be simple to contrast any aspirational vision for universal healthcare with the party that is in court right now trying to take healthcare away from millions to line the pockets of the wealthy.
5
@Scott Keller Indeed, a debate that describes aspirations for negotiable specific plans
I sometimes don't understand the tactics on the liberal side of the healthcare debate. They overintellectualize when they need to go back to the basics of selling their plans to as broad a group of Americans as possible. A rapid implementation of Single payer which ensures many people lose their preferred doctor all at once is not going to fly and will give Republicans all the ammunition they need to animate their base and the public at large against it. A public option that puts pressure on private insurance and if well implemented will gradually shift the system towards single payer and is a much smarter strategy. Why is it so hard to understand this?
12
@Miguel Valadez
Great response. Sometimes politicians are so enamored with their self perceived enlightenment they ignore the homeostatic nature of the electorate to radical change that could lead to unperceived complications in addition to disruption to the vast majority of the electorate who are satisfied with their coverage.A graduated approach to that expands on the affordable care act pays some homage to our existing system while expanding opportunities to the uninsured.
3
@Miguel Valadez Please explain why a Medicare For All system would "ensure that many people lose their preferred doctor"? A single payer system (as opposed to a socialist system, like Britain's NHS or the U.S. Veteran's Administration) means that health care is publicly paid for but privately delivered. The payer would change but there's no particular reason you would need to go to a different doctor. Why is it so hard for you to understand this?
2
@Leslie J. Matthews Obama promised fatefully that no one would lose their doctor just by expanding the existing private insurance system. He was wrong. Please explain how you would remove a key plank of the system and replace it with government without affecting its delivery...it will be hugely challenging and create lots of uncertainty and government
faults which the republicans will lap up with glee. So carry on ...be ideological and prepare to lose...a lot.
Paul Krugman, I have read your column, but comment here about the many comment writers who find Universal Health Care for us Americans as impractical, impossible, even utopian (nobody used that word but I do below).
Then I read a column in my Swedish newspaper, DN by Professor Emeritus Leif Lewin under the heading Utopia still has a place in international politics and under that a photo of the president who believes that the only politics possible are those that place the single state's interest first - realism is the name for that.
As concerns Universal Health Care I quote directly - my translation - two sentences by Professor Lewin.
"I say along with the Norwegian international politician Edvard Hambro that politics is to make possible tomorrow what seems impossible today."
"Many improvements and discoveries have actually at one time begun as utopias."
Yes, today it is impossible to make America Sweden - as concerns health care - but I can dream that among the candidates there is one and only one who can make America Sweden tomorrow.
Only-NeverInSweden.blogspot.com
Citizen US SE
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Could we have a more "to the point " discussion?
- Yes, Medicare is popular among Senior citizens, but please mention that it's not generally accepted by providers because of LOW reimbursement rates! Meaning - private insurance premiums currently compensate for Medicare costs!
So, how can Medicare be further expanded, who's paying for the difference?
- Second: yes, the current bureaucratic maze in healthcare is super costly and terrifying to navigate for patients and providers.
However, how many "side" jobs are we talking about, not doctors and nurses, but all the administrative and insurance- related positions? Nobody dears to mention the glorified "Service Economy" that offered so many jobs to people left out from manufacturing or other directly productive positions.
How do you transition to the non-profit "public" system displacing all those jobs?
Sure, the example of Europen healthcare systems is tempting, but those countries implemented them from the beginning, as they rebuilt their economies after WW2. And everybody bought into these plans, without loopholes for special interests.
Please, be fair to the American people and offer a full disclosure of all the problems, disruptions and hurdles of a transition this late in the game (not to mention how many loopholes will still be thought of, by all the usual interested parties).
Please disclose numbers: about costs, taxes, jobs!
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@InNorCal A few observations:
As a Medicare beneficiary since 1995, I've NEVER encountered a physician that did not accept Medicare. However, there are too many physicians that don't accept MEDICAID.
The USA could have just as easily adopted universal coverage after WW 2, but I think this link to another NYT article explains why that path was not chosen...and that in retrospect was a mistake.
https://www.nytimes.com/2017/09/05/upshot/the-real-reason-the-us-has-employer-sponsored-health-insurance.html
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@InNorCal Good point, as a large percentage of jobs created over the past decade or so are healthcare-related. But how many of those are "breadwinner" jobs, and how many actually deliver healthcare (even indirectly?). Many are "coders", "collectors", "negotiators", "arbitrators/litigators", "actuaries" and IT/HR support for insurance companies to NOT pay valid claims... in which case those jobs can/should be eliminated... or replaced w/ fraud prevention roles.
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There are several ways I want to take issue with Paul Krugman's column. Although Medicare for All was first popularized by Bernie Sanders's 2016 Democratic primary campaign, in the 2020 Democratic primary race, Elizabeth Warren and Kamala Harris are also top tier candidates who support Medicare for All. At this point it seriously distorts political reality to identity the policy only with Sen. Sanders. Currently, even under the ACA, more families get health insurance coverage through a group policy offered by one the parent's employers than through the exchanges. With an employer group policy generally the employer pays part of the premium and the employee pays the remainder as a deduction from their paycheck. If Medicare for All replaces premiums with taxes, would both employers and employees be taxed?
Although people talk about Medicare for All getting rid of private insurance companies, currently people on Medicare use private insurance in several ways. Medicare beneficiaries can purchase Medicare Supplemental insurance which covers some or all of the deductibles and copayments that Medicare doesn't pay. Some people convert their Medicare coverage into a Medicare Advantage Plan meaning Medicare pays a private insurance company a monthly fee to care for that person in an HMO or PPO. These plans may or may not have prescription drug benefits. Medicare patients who don't otherwise have prescription insurance can enroll in Part D prescription plans from private insurers.
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It seems to me Krugman is making one major mistake in his assessment: He's counting on Biden's two-prong approach to be sustainable, even if the GOP took back control of the political system. But things being what they are, they'd most probably try to dismantle the public option, as they have done already. Of course, the insurance lobbyists would contribute to no small degree.
Sander's Medicare for all would make that impractical, most probably impossible.
Also, relieving businesses from the onus of having to pay for private insurance is really akin to a major tax cut.
Lastly, I can say as a Norwegian citizen that a public health system works near flawlessly. I can choose my own GP, if my monthly expenses for drugs exceed 20 USD, they're covered by the government, and the same goes for medical treatment. The system works just fine, it's been in place for generations, and we have a conservative government that wouldn't dream of abolishing it.
(And, no, Norway's oil wealth is not invested domestically, so that doesn't contribute, and we've had this system long before oil was found here.)
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While I do agree that everyone should have access to some form of basic healthcare, Universal Health Care costs dearly.
Surely, the Canadian model sounds enticing but try quizzing folks in Canada and they’ll all gripe about how much they pay in taxes compared to the US. Sales tax (federal+ state), income tax, gas tax, etc.
For example, the sales tax alone in Québec is 15% and an income tax of 30-50% on top of that, depending on your income.
Having lived on both sides of the border, I prefer the HMO model, where I’m not losing 2/3 of my income in taxes for a ‘universal’ health plan that I may not be using regularly to justify the ‘dauntingly burdensome taxes, not to mention the long wait times for surgeries and dental, eye and physio exclusions galore.
Of course, there’s a lot of room for improvement in the Affordable Care Act, but the ‘universal’ option maybe a bridge too far, too soon.
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@CanAmericanNot entirely true. Yes, sales taxes are high by US standards but vary province to province ( 0% in Alberta to as high as 15% in some provinces). Nobody pays 2/3 of their income for health care. Federal and provincial income tax are imposed on a scale based on income. For example, my wife and I pay about 22.5% combined federal and provincial income tax and covers all services provided by both levels of government, not just health care as you seem to believe.
As for wait times, they vary depending on the severity of the illness or injury - quite quickly for something that is life threatening. As for "dental, eye and physio exclusions galore" you are wrong again. These are covered by private insurance (either employer based or purchased privately) and I can usually be seen by my dentist or physiotherapist within a day or two of making an appointment.
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@Rob
Clearly if you’re paying for dental and physio thru private or employer-based plans on top of the heavy taxes, it begs the question... “why even have this ‘universal’ healthcare plan in the first place (when you’ve contributed to it thru sales and income taxes among other things, as you say)”?
Not sure about Halifax, but my experience in Ontario and Quebec had been quite different (being the most populous provinces of Canada) and that of my extended family and friends, who are lifelong residents there.
Apart from the heavy tax contribution in QC (with broken roads and highways ‘toujours’ in Montreal), their residency/eligibility requirements for quite onerous for this ‘so-called’ Health plan, to say the least (and God forbid, if you’re an Anglophone/AngloAmerican living in QC or worse, a visible minority in ‘la belle province’ .
Anyway, Certainly sounds like Alberta’s example would be the one to emulate across Canada and maybe even the US.
1
I think what is side stepped here is the issue of dysfunction the US has arrived at, and without knowing all Sanders has said, what Krugman quoted sounds about right.
The US health care involves incredible, unjustified prices for drugs and many services (usually technical/procedural) and an army of administrators/clerks; it will take enormous political will, basically a peaceful revolution, to resolve this. Medicare for all would work, or an extremely solid US wide public option that is carried out by the government and has pricing power. So guaranteed medicare buy in with premium support, stopping medicare advantage (while allowing supplemental insurance for nonessential services) and having Medicare negotiate drug and other prices while still allowing private coverage for those who want it may work best in terms of electability and benefit for the public. Private insurance probably would become an absolute niche product over a couple of years.
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Sanders in 2016 was a spoiler. He stayed in the campaign even after he lost. He kept attacking Hillary that she was supporting Wall Street. Hillary lost the electoral election for many reasons. Sanders politics may be popular in Vermont but may not appeal to the rest of America. Americans do not want to pay higher taxes.If the Democrats run on a platform of increasing taxes to pay for universal health care it would be unpopular. Unions including teachers and civil servants have health care through their employers and paid for by the employer. Would they want to give up their plans and pay higher taxes?
Sanders keeps attacking Wall Street as an evil entity. Yet Wall Street investment is important to many private and public pension plans. He also indicates taxing Wall Street will pay for his programs. The truth is that a European or Canadian model must be funded by higher taxes.
The Democrats need a candidate and campaign to defeat Trump.
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@JAB
I am not sure if these are good faith arguments.
1) to my recollection, Sanders campaigned for HRC
2) Trump was to a large extent elected against the status quo. Trumps best known utterance about health care was that "everybody should be covered" and that he would not touch the social net.
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Paul is correct that the Democratic Party is shooting itself in the foot with its radical positions on healthcare. Asking people to give up their current employee health plans is suicide and a sure way to loose the election.
Providing the option of national single payer plan for those who are uninsured, under insured or in an employer plan that is bad should have the option to opt in. Eventually, companies will look to unload their employees onto the national plan in an effort to free themselves up from having to provide and administer health plans.
This should allow for greater competition between public and private health plans and therefore help to rein in costs.
Only the Democrats can pull this off, as the Republicans have no health plans to offer the general public other than fear of socialism.
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I can't wait for the primaries to be done with so that the Democrats can finally focus on winning the presidency and the senate back.
This infighting is just foreplay. The real job comes to convince voters to turn up and vote. All of them. Given the abhorrent tactics of the GOP to suppress voters this is a challenge in itself.
If people care enough about their health, their jobs, entitlements, and inclusion they will vote the GOP into oblivion. Unlike most candidates Ms. Warren actually knows what she is talking about. She has a vision for America and can bring the fight to Trump's abhorrent policies.
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Americans pay so much more for health care than every other developed country. It makes me wonder if we aren’t subsidizing other countries health care with out sky high costs per person.
I just believe that health insurance shouldn’t be a function of where you are employed. It should be a function of end consumer choice. Right now employers are saddled with choosing insurance that’s best for them and maybe not the best for many individuals working for them. People should t be staying at jobs because the health insurance is good. They should have good health insurance regardless of where they are employed.
What kind of sense does it make to change insurance companies and fill out all kinds of paperwork every time people switch jobs which is like every 2-3 years. With health insurance right now, we aren’t getting the best.
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Krugman is not too helpful. He says, re Sanders, ' the required tax increases would be daunting.' Daunting? Meaning non affordable? LIke ACA premiums and medical care costs are 'daunting'?
But how come in dozens of countries, the required taxes are NOT daunting. If they were, the populace would be marching in the streets in various colored vests, forcing their govts to listen and change.
Canada has had universal HC since 1966. It's now 2019. Just how daunting has it been for them? We still can't get have they've got. Canada's so close. Go over the border and interview a few Canadians about this.
And if Sanders' proposed taxes would fall far short, per 'independent estimates' (who?), then how come the taxes in dozens of countries do NOT fall far short, but have enabled HC for all for generations?
If Krugman, the economist so concerned with economic justice, can't or won't address this, then his columns are a waste.
This is one of the top issues in one of the most significant elections in US history. And we get a column about 2 candidates behaving badly? Thanks a lot, for leaving a lot of the public confused and in the dark.
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@Meredith,
"But how come in dozens of countries, the required taxes are NOT daunting."
Because Americans inflict high costs on themselves by acting stupidly and through our sense of entitlement: https://www.theatlantic.com/magazine/archive/2019/07/american-health-care-spending/590623/
Citizens of other countries don't behave that way. If we want their healthcare systems, we're going to have to learn to behave differently. I'm waiting for the first politician who will tell the truth ... and waiting ... and waiting.
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@Meredith I totally agree with all you said. Premiums plus deductibles plus staying in jobs you hate plus changes of doctors plus you name it. I want to pay my taxes and have decent health care and peace of mind, including the expansion of Medicare to other needs, such as dental, and long term care! Please, TAX ME!!!!
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@Meredith Agree. This was a lazy man's column. We should expect more expertise out of our experts.
1
Politicians cannot solve the health care issues in the U.S. They are all too beholden to special interests (i.e. the insurance companies, big pharma, the doctors, the coding industry, the collection agencies and attorneys and even the doctors). None of those making the lion's share of the profits have any incentive to change the current, corrupt system.
It's literally going to take a huge movement of the people to stand up to all of the special interests and simply refuse to pay the "shakedown" that is the U.S. system of health care. Americans have become slaves to their doctors and insurance companies and unless and until they demand a total reform of the system, things are only going to get worse.
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Krugman has discussed the problem of cream skimming in the insurance industry many, many times. He has argued that we have to mandate that everyone get insurance, otherwise only the ill will get insurance.
Here he argues that a system where the government has to insure all takers and private insurance can take the good risks can be made to work as well as a single-payer system.
Those positions are on the surface very contradictory. The end game is clear. Private insurance takes the good risks and charges low premiums. The government pays for the expensive, high risk patients. And conservatives talk about how the government can't do anything right because their cost per patient is so much higher.
Note: My understanding is that Warren's plan does not prohibit private insurance. Instead it says that private insurance can't cover anything that the single-payer system already pays for. Medicare supplement plans pay for costs that Medicare doesn't pay for.
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