Berned By Health Care Truths

With the primaries over, Bernie Sanders' damage to Hillary Clinton's general election prospects looks to be less than that inflicted by Donald Trump to Republican White House aspirations. Still, Bernie hasn't given up on further forcing Hillary to the left in the Democratic Convention, which can harm mainstream Americans.

For instance, a minimum wage of $15 in expensive cities may be fine, but applying that nationally (compared to $12 proposed by Hillary) can seriously depress employment and the economy, plus raise costs. Other stances with similar downsides are opposition to trade, breaking up big banks (instead of just regulating them better) and supporting aggressive union action. An example of the last is Verizon workers who after a long and bitter strike won costly concessions at company and customers' expense.

The irony is that on one major issue where Bernie's views are right, which is in health care, he risks harm to the cause by shouting them from the rooftops. It's the equivalent of alerting your quarry before the hunt, or revealing your battle plans in advance to the enemy. That's why I can perfectly understand Hillary's restraint till the election is over. The question is, does Bernie not get it, or is he just too self absorbed amidst the media coverage and adulation of his supporters to really care?

Many of these Bernie declarations are contained in his Medicare for All proposals on his website, particularly on what they'll cost and how he would pay for them. Foremost among these is that universal coverage through single payer system will cost a lot less than our present $3 trillion a year. Bernie sees savings of $6 trillion over 10 years, or nearly 20%.

Other advanced economies incur half or less than the U.S. in per capita expenses. So these estimated savings by Bernie are not only realistic but can be easily and vastly surpassed with reforms done right. Moreover, the single payer system can maintain or improve quality while also stimulating the economy because employers no longer have to incur added health costs for workers hired by them.

These enormous savings are sure to adversely affect the largest players in the health industry that also happen to be the biggest buyers of political influence,  And remember, their actual spend is probably multiples of the official figures, and they can vastly increase it if the perceived threat to their interests rises. This explains Hillary's reluctance to match Bernie's rhetoric and the root problem with his insistence on its adoption into the Democratic platform during the Convention.

Such action will amp up funding and efforts by well endowed healthcare providers and insurers to beat Democratic candidates in the coming general elections. Smart individual contributors can (and do) dodge disclosure laws on political giving to hide industry linkages.

Doctors and insurers for instance can use spouses and children so that their contributions appear to be coming from home makers and students. In any case our laws on Super PAC (non) disclosure and the deceptive names they use obscure their true identity from the average American. We also tend to trust doctors, so industry self serving ads with doctors in white coats solemnly denouncing reforms can sway many voters who do not see through the subterfuge.

Second, there is almost no chance of getting "Medicare for All" legislation directly passed by Congress even if Democrats regain a narrow majority in both houses, leave alone without it. Passage of the measure in the Senate alone will need at least 65 Democrats among the 100 Senators to get a 60 filibuster proof majority. This is because (going by the experience with the public option in 2010) all Republicans and five Democrats bought or intimidated by health lobbies can be expected to oppose it. Democrats last had that kind of 65+ majority in 1967 and are at 46 (including two Democratic leaning Independents) right now.

Remember, Hillary's 1993 drive for universal health coverage was foiled mainly by the health insurers - without doctors and hospitals - joining forces with the Republicans and Libertarians. That too post elections with Democrats firmly controlling both Houses. The obstacles would be much worse now, with Democrats in a minority in Congress, health providers teaming up with health insurers to defeat Medicare for All, and during a frenzied election season. Hillary learned her lesson, and this explains her restraint at this time.

The practical path with some chance of success to Medicare for All is the approach hinted at by Hillary - make a concerted push for the strong public option, AFTER the elections. If Medicare is allowed to offer plans at cost in public exchanges, it will win out over private insurers, given its efficiency of scale, simplicity, buying power, and absence of a profit objective.

To make all this happen, Democrats need to score big in the upcoming Congressional elections, apart from winning the White House. The chances are much better by attracting centrist voters and letting lie the sleeping dogs of medical special interests. That means Bernie should drop his several wrong headed ideas - and this lone valid one about single payer - for inclusion into the Democratic platform at the upcoming Convention.