You will have noticed that Sanders single payer plan has been extensively attacked. It has been dismissed by Paul Krugman and savaged by Vox, which is turning into the 21st century version of the old New Republic (the Marty Peretz New Republic that marketed its liberal reputation to put across reactionary ideas).
These logic behind these political attacks is pretty simple. Sanders has been hammering on a problem, a massive problem, with healthcare in America. It is fantastically expensive; and, for the majority of people, that is, those who live in households thatmake below around 100 thousand, it is a subject of constant, rational worry, since it is precisely those households for which every rachet upward of the medical machine makes medical care ruinous. 32 million non-elderly Americans are still uninsured, according to the Kaiser Family Foundation. And even for those who are insured, According to the Commonwealth Fund:
“New estimates from the Commonwealth Fund Biennial Health Insurance Survey, 2014, indicate that 23 percent of 19-to-64-year-old adults who were insured all year—or 31 million people—had such high out-of-pocket costs or deductibles relative to their incomes that they were underinsured. These estimates are statistically unchanged from 2010 and 2012, but nearly double those found in 2003 when the measure was first introduced in the survey. The share of continuously insured adults with high deductibles has tripled, rising from 3 percent in 2003 to 11 percent in 2014. Half (51%) of underinsured adults reported problems with medical bills or debt and more than two of five (44%) reported not getting needed care because of cost. Among adults who were paying off medical bills, half of underinsured adults and 41 percent of privately insured adults with high deductibles had debt loads of $4,000 or more.”
Even this survey doesn’t represent the reality of the medical care burden. Those in the 19 to 64 group are connected by family ties to those in the 64 and above group, and often have to dip into what savings they have for medical expenses that the retirees can’t pay.
This survey received a lot of news coverage. It is relevant to the medical care crisis:
“Approximately 63% of Americans have no emergency savings for things such as a $1,000 emergency room visit or a $500 car repair, according to a survey released Wednesday of 1,000 adults by personal finance website Bankrate.com, up slightly from 62% last year. Faced with an emergency, they say they would raise the money by reducing spending elsewhere (23%), borrowing from family and/or friends (15%) or using credit cards to bridge the gap (15%).”
It is in this environment of economic precarity that we are seeing a rather amazing rise in the cost of medicines: From Business insider:
“Cost trends for prescription drug coverage are projected to increase by 8.6% in 2015 and by 11.3% in 2016 for active plan and retiree plan members under 65, according to a survey released Thursday by benefits, compensation and human resources consulting firm The Segal Group Inc. That compares with an increase of 10.7% in 2014.
This is of course an impressionistic survey of the medical landscape, but it is enough of one to pose the question: is there a problem here?
This question is not, however, posed by any of the attacks on Sanders so far. What one wants is a comprehensive survey of the costs to the American public of medical care, and then a comparison of the two plans, Clintons and Sanders, which address it. Instead, what we are getting is the well known solution-suck program. One concentrates on the flaws in a solution to the elimination of everything else. In this way, we forget that even if we have no plan, we have a crisis in costs in the US. The difference, of course, is in who is going to pay for it: whether it is going to continue to be on the backs of the working class, or whether the costs are going to be met through some universal medical care system. The second question is whether the costs can be mitigated or even lowered by government action.
What is never said about the later question is that the costs are siginificantly increased by government action. There are three drivers of cost in the US: guilds, monopolies and intermediaries. Guilds are labor forces that are artificially restricted by government required licences. Monopolies are both IP driven and trust driven. And intermediaries are complex interactions that include both insurance companies and health care providers. When I have to go to a doctor to get a prescription to get a drug, I am paying an intermediary premium.
We might well want doctors and nurses to be licenced, and patent protection to work. But this doesn’t mean that we have to have the system we have now. For instance, patents, as Dean Baker has suggested, should better be treated as a premium on licencing products. Instead of the inventors of x drug having a 20 year monopoly on producing it, Baker’s suggestion is that the government auction the design of the drug and give a percentage of the profits of the drug to the inventor from all those who bid to produce it. Thus, we would have both competition and a fair compensation for invention.
In any case, the solution-suck strategy is being pulled on Sanders. The way to fight back is to bring the conversation continually, obsessively back to the problem. Because in reality, the solution-suck strategy is simply neo-liberalism’s way of keeping things the way they are. And the way they are is becoming, increasingly, a horror.