Bernie Sanders on Healthcare

Bernie believes that the challenges facing the American healthcare system need to be addressed immediately—they are a matter of life and death. He has always believed that healthcare is a human right and should be guaranteed to all Americans regardless of wealth or income. He prizes the health and wellness of individuals over corporate profits. Additionally, he supports future legislation to curb drug costs and tackle fraud in the industry. Altogether, universal healthcare serves as a strong foundation for his policy goals.

Affordable Care Act (Obamacare)

Though he voted for Affordable Care Act, Bernie believes that this measure has not gone far enough to provide adequate healthcare for all.

So, what’s the solution?

Check out Bernie’s proposal on Medicare for All, his version of universal healthcare.

In short, single payer health care will save taxpayers about $500 billion per year even including the initial costs to train more doctors and nurses. Canada and the other 19 wealthiest countries pay about 60% as much on health as we do, for care that is always free at the point of service, and that results in an extra three years of lifespan.

Medicaid

Until comprehensive universal healthcare is passed, Bernie supports expanding Medicaid coverage to more Americans.

While proposing comprehensive universal healthcare legislation, Bernie has consistently supported the expansion of Medicaid coverage. At the same time he has fought repeated efforts to cut Medicaid funding.

He was instrumental in increasing Medicaid coverage through the Affordable Care Act (ACA). And after passage of the ACA, Bernie continues to fight for Medicaid. For example, in a 2011 letter to President Obama he wrote:

“Medicaid is a vital lifeline for some 72 million Americans. Two-thirds of all Medicaid spending supports senior citizens and persons with disabilities. Cutting Medicaid would jeopardize the quality of healthcare, long-term services, and nursing home care for tens of millions of Americans. There are significant cost issues in America’s healthcare system that must be effectively addressed, but these challenges will not be remedied by benefit cuts to vulnerable Americans.”

Gotcha. But go back: What is Medicaid, and who does it cover?

Medicaid is a public insurance program jointly administered by federal and state governments that covers low-income families and individuals—including children, parents, pregnant women, seniors, and people with disabilities.

So, how did the Affordable Care Act expand Medicaid coverage?

The ACA expanded Medicaid coverage by raising the means-testing threshold to 138 percent of the poverty line ($26,951 for a family of three), which in turn made more families and individuals eligible for Medicaid. The ACA incentivizes states to increase Medicaid coverage by offering nearly full funding for the expansion (i.e., 100 percent in the first three years and 90 percent after). But as we know, the choice to accept this funding is ultimately up to each state.

According to the Center on Budget and Policy Priorities, 28 states and the District of Columbia expanded Medicaid as of May 2015. The CBO estimates 14 million more adults and children will enroll in Medicaid by 2025. Bernie has repeatedly argued that even more Americans would get access to quality care if governors from the remaining states elect to expand Medicaid.

How much money does this save?

By most estimates, Medicaid is more cost-effective than private insurance. And in spite of the refusal of some states to expand Medicaid through the ACA, researchers at the Commonwealth Fund reported that expanding these programs under the ACA would, on average, cost less than one percent of their budgets.

According to another independent study by RAND, “the cost of expanding Medicaid under this reform would be lower than the cost of providing uncompensated care to their uninsured residents.”

In other words, total healthcare costs are greater when people go without coverage. Medicaid saves taxpayers money. And, Bernie believes it’s simply the right thing to do.

Speaking of Bernie, what has he done about it?

In early 2015, he introduced the Medicaid Generic Drug Price Fairness Act, a bill designed to hold down spending on generic drugs in Medicaid.”

Some generic drug prices have increased as much as 100 to 1000 percent in recent years. His bill requires drug manufacturers to rebate Medicaid for increases in generic drug prices that outpace inflation.

Americans pay higher prices for prescription drugs than any nation on earth. The same prescription drugs can cost 10 times more in the U.S. than just across the border in Canada. Bernie has long advocated for the ability of the government and individuals to re-import prescription drugs from Canada and other countries. In 2009, he supported an ACA amendment to allow re-importation (no thanks to the efforts of pharmaceutical lobbyists).

Yeah, but drugs are only important when you’re sick. What about staying well?

Glad you asked. Medicaid expansion is only effective if clinics, doctors, and hospitals accept it. That’s why Bernie fought hard to include a provision in the ACA to fund new community health clinics. It was a deft move that The Intercept described as making an “indelible mark on American healthcare, extending the number of people served by clinics from 18 million before the ACA to an expected 28 million next year.”

Tell me more about community health clinics.

Community health clinics are, by design, placed in underserved communities like rural areas and the inner city. They provide healthcare to everyone regardless of finances or coverage. They can also be a much-needed engine of economic activity. For further reading, this article from the Center for American Progress details many ways community health centers benefit low-income Americans and other traditionally disadvantaged communities.

Check out these graphics from the same article below—

community-health-centers-serve-minorities

community-health-centers-serve-low-income-people

Medicare

Everyone should have access to universal healthcare through “Medicare for All.” That is to say, Bernie believes that the current single-payer system must be expanded so that it applies to all American citizens. Though he voted for the Affordable Care Act, he believes that the reform measures haven’t gone far enough to provide adequate healthcare for all.

Got it. But let’s take a step back, what is Medicare again?

Medicare is a national social insurance program administered by the federal government. It provides health insurance for Americans aged 65 and older who have worked and paid into the system. It also provides health insurance to younger people with some disabilities like end-stage renal disease and amyotrophic lateral sclerosis.

If I’m not 65 yet, how does ‘Medicare for All’ affect me?

While the Affordable Care Act increased the rate of America’s insured, it still relies on markets that vary from state to state. Medicare is part of a greater social safety net that collectively works to reduce structural poverty. This system is already a form of universal coverage that redistributes benefits to those who need them most. It also pools risk — between the healthy and the sick — and ensures the rights of all beneficiaries to essential healthcare.

So, what does Bernie think about providing ‘Medicare for All’?

Bernie has made his stance clear. For example, in his “Agenda for America“ he says:

“The United States must join the rest of the industrialized world and recognize that healthcare is a right of all, and not a privilege. Despite the fact that more than 40 million Americans have no health insurance, we spend almost twice as much per capita on healthcare as any other nation*. We need to establish a Medicare-for-all, single-payer system.”

*According to the Peter G. Peterson Foundation, the U.S. spends more than twice as much per capita on healthcare as the average developed country does.

Okay, so, what has he done about it from a policy perspective?

Aside from publicly advocating for “Medicare for All”—both in the Senate and in the media— Bernie also introduced legislation requiring the payment of an additional rebate to state Medicaid plans in the case of price increases for generic drugs.

Err, can you remind me how a single-payer system even works?

No problem! Check out this video:

Universal Healthcare

Everyone should have access to universal healthcare through a single-payer system.
Bernie believes that we need to expand a Medicare-for-All, single-payer system. Though he voted for Affordable Care Act, he believes that the measure hasn’t gone far enough to provide adequate healthcare for all.

Got it. But let’s take a step back; can you explain “universal healthcare”?

There are a lot of terms—like single-payer system—used to define it, but the World Health Organization has a pretty good rundown. The key is that universal coverage ensures that everyone, rich or poor, has access to the health services they need. If you’re more of a visual person, check out this video for a handy explanation.

Does Bernie want the government to completely take over the healthcare system?

No. The United Kingdom’s National Health Service is an example of a system where the government owns and operates the public hospitals and employs the staff in those facilities. Alternatively, Bernie is proposing a Medicare-for-All system of social insurance that is found in Canada, continental Europe, and in other developed nations.

In this system, every American would be automatically enrolled into Medicare. This is commonly referred to as “Medicare for All.” Like the systems in many other industrialized countries, private practitioners could still provide care, but everyone would be covered by a national health care plan. This allows for private delivery and public financing to insure guaranteed health care for all and effective cost control. This is how Medicare is delivered today for all Americans over age 65.

Some people get spooked about the regulations. You know, “long lines and death panels.”

There’s a lot of rhetoric and misinformation. We like Bernie’s method of confronting these head-on:

Wait a minute, this all sounds like magic. How the heck are we going to pay for it?

Bernie’s proposal would amend the tax code to create the American Health Security Trust Fund, which would be financed by various tax revenues, credits and subsidies. It’s not set in stone, but the tax revenues in the draft include a new healthcare income tax, an employer payroll tax, a surcharge on high-income individuals, and a tax on securities transactions. So, basically, it’s not wishful thinking at all.

But, more importantly, single-payer healthcare controls costs and so would save us money in the long run.

How does single-payer healthcare control costs?

In single-payer systems (and how Medicare works right now), the government negotiates a fee schedule with healthcare practitioners. This is an essential component to controlling costs. See this explanation from healthcare economist Uwe Reinhardt on the benefits of having one price negotiator (the government):

“[P]rices for identical products or services in the U.S. tend to be, on average, twice or more than the prices of the same products and services paid in other countries…. Prices are high here because the payment side of the health system is so fragmented that few payers have sufficient market power to bargain for lower prices.”

In a single-payer system, the government can use its leverage to negotiate more reasonable prices for basic medical services.

It also serves to incentivize doctors that choose to practice in fields where help is needed the most – primary care, family medicine, and pediatrics. An expanded system has the added benefit of giving Medicare more negotiating power when purchasing pharmaceuticals and medical devices. Remarking on similar legislation, economist Gerald Friedman, made the follow estimate:

“[T]he United States could save an estimated $592 billion annually by slashing the administrative waste associated with the private insurance industry ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion)……Over time, reduced health cost inflation over the next decade would save $1.8 trillion, making comprehensive health benefits sustainable for future generations.”

Fine, but I’m healthy. Why should I pay for someone else’s healthcare?

Well, you already do! Here’s how Blue Cross Blue Shield – the largest private insurer in the country – describes private health insurance: “By pooling the resources of a local community, the power of everyone’s premiums together could afford to pay for the individual members’ care when needed. It’s a simple concept with enormous benefits.”

The idea of private health insurance originated from the notion of paying for the healthcare of others. Private insurance began in the U.S. in Texas in the early 1900s when groups of public school teachers would each chip in a monthly fee to cover potentially large hospital costs of one of the group members down the road. Our modern health insurance system evolved from this simple idea of defraying the cost of medical expenses. Even with private health insurance your money is being used to cover the care of others, and vice versa.

But with private health insurance our money is only going to other people who pay premiums, right?

Not exactly. Much of the health care costs of uninsured Americans’ is actually borne by insured Americans. Uninsured patients will receive emergency care in a humanitarian obligation, and when they receive that care — often via hospital emergency rooms — the costs are regularly uncompensated as these patients can not afford to pay. To compensate for these costs, hospitals charge private and public health insurance providers more. The costs of uninsured Americans are usually, then, borne at least in part by insured Americans and taxpayers.

So, how will universal healthcare be different?

We will no longer be paying for CEO bonuses or other instances of company profit. There is no profit motive in a public healthcare system.

Just as programs like Social Security, Medicare, and Medicaid are part of a greater social safety net that, taken collectively, work to reduce structural poverty, so is universal healthcare.

So, what has Bernie said about universal healthcare?

Bernie has made his stance clear. In his “Agenda for America“ he says:

“The United States must join the rest of the industrialized world and recognize that healthcare is a right of all, and not a privilege. Despite the fact that more than 40 million Americans have no health insurance, we spend almost twice as much per capita on healthcare as any other nation. We need to establish a Medicare-for-all, single-payer system.”

What has he done about it, from a policy perspective?

Bernie has advocated for universal healthcare publicly and on the Senate floor, specifically introducing The American Health Security Act of 2013. Aside from publicly advocating for “Medicare for All” — both in the Senate and in the media — he introduced legislation  to require the payment of an additional rebate to the State Medicaid plan in the case of price increases for generic drugs.

I’ve been waiting for something like that — I want to read the whole bill.

Sure. Take a look.

What would be the impact of universal healthcare?

A single-payer system would address the huge amount of money wasted on billing and administration. Creating a simple system with one payer covering all Americans would result in an enormous reduction in administrative expenses. With this system in place, the government will have more money to spend on healthcare and disease prevention, instead of paper pushing and debt collection.

Further, a single-payer system would create jobs and lift a financial weight off of businesses that are increasingly crushed by employee health expenses. Lifting this burden of employee healthcare expenditures will free small business owners to invest in expanding their companies—in turn creating more jobs.

Mental Health

Bernie believes that everyone has a right to adequate mental healthcare. In fact, one of his ACA provisions dramatically increased support for community health centers, which provide affordable primary care and mental health counseling to the underserved. The law authorized $11 billion to improve and expand community health centers over a five-year period.

Hold on. Tell me more about the scope of the challenge.

Mental Health America, along with a coalition of mental health agencies and advocates, succeeded in getting the Mental Health Parity Act signed into law in 2008, requiring insurers to provide equal coverage to both physical and mental health needs. Despite this, individuals and families still face shortages of mental health providers and treatment facilities as well as gaps in insurance coverage.

But I thought we already have the Parity Act?

Even for those who are insured, 21 states have refused the ACA’s provision to expand Medicaid coverage for citizens of their states, following the Supreme Court’s 2012 ruling allowing states to opt out. The District of Columbia and 26 states are expanding Medicaid, and three states are considering expansion.

According to John Bartlett, a psychiatrist and senior project advisor of the Primary Care Initiative of the Mental Health Program at the Carter Center in Atlanta, 16 of these states “have largely chosen minimal mental health benefits.”  Moreover, some employer-based plans can have older, less generous mental health benefits grandfathered in.

As a result, an estimated four million uninsured people in need of mental-health services will be “locked out of the mental health insurance system, and therefore lack access to timely, quality mental health services and a consistent source of care.”

Just how prevalent are mental disorders in this country?

Take a look at these infographics from the National Alliance of Mental Illness.

A study by SAMHSA breaks down mental illness by state below:

map-mental-illness

OK, I’m convinced it’s a problem. What does Bernie say about it?

He believes “we must make sure that mental health services are available to all Americans regardless of income.” And as Chairman of the Senate Committee on Veterans’ Affairs, he’s particularly concerned about expanding access to mental health services for veterans.

So, what has Bernie done about this?

His provision in the Affordable Care Act dramatically increased support for community health centers, which provide affordable primary care and mental health counseling. The law authorized $11 billion to improve and expand community health centers over a five-year period.

Bernie introduced The American Health Security Act of 2013, which provides every American with affordable and comprehensive healthcare services through the establishment of a national American Health Security Program that requires each participating state to set up and administer a state single-payer health program. It was written to provide inpatient services, long-term care, a broad range of services for mental illness, and care coordination.

And closer to home, he also shepherded Vermont’s Mental Health Parity Act, requiring insurers to provide equal benefits for mental and physical illnesses.

Hungry for more? Here are a 13 more bills Bernie proposed during the 113th Congress alone that would improve mental healthcare for veterans, seniors, and children.

Impressive. But what about making our system even better?

Bernie believes the only long-term solution to America’s healthcare crisis is a single-payer national healthcare program. He has cited the success of Medicare as an example. It’s open to all Americans over 65 years of age and has been a resounding success since its introduction 48 years ago. That’s why he’s advocating to expand Medicare to cover all Americans.

Prescription Drugs & Drug Manufacturers

Bernie tackles rising drug costs while still promoting innovation in the industry.

As part of a larger agenda of economic equality, Bernie is committed to creating fair drug prices. At the same time, he has a history of supporting innovation in the field of HIV and AIDS medication that would benefit both patients and corporations. In 1999, Bernie was the first politician to take senior citizens north of the border to Canada to buy more affordable prescription drugs. Around that same time, Bernie also took breast cancer sufferers northward, where they could purchase medications in Canada at one-tenth the cost they’re sold for in the United States.

I know drugs are important when you’re sick, but why is this an issue?

Sharp price hikes not only impact consumers, hospitals, and pharmacists, but strain the budgets for Medicaid, Medicare, the Department of Defense, and the Department of Veterans Affairs. With regards to the Generic Drug Price Fairness Act, the nonpartisan Congressional Budget Office (CBO) estimated the policy change would save taxpayers $1 billion over 10 years.

So, how has Bernie framed the challenge?

“Every single year, the major drug companies are ripping off the American people to the tune of billions of dollars a year because of fraudulent practices. Virtually every major pharmaceutical company has either been convicted of fraud (i.e., ripping off the federal government, state government, or individuals) or else has reached a settlement.”

Want to hear more? Watch this video.

Need it plainer than that? How about this: “It is unacceptable that Americans pay, by far, the highest prices in the world for prescription drugs.”

What’s he done about it in Congress?

Bernie sponsored the Medicaid Generic Drug Price Fairness Act that makes manufacturers pay a rebate to Medicaid when prices of generics increase at a rate steeper than inflation. He also introduced the Medical Innovation Prize Fund Act, which creates a medical innovation prize fund that would fundamentally restructure the system of financing research and development of new medicines as well as dramatically reduce their prices.

Nutrition

While income inequality rises, the increase in food and nutritional funding is essential.

Bernie believes that individuals who truly need assistance should not be denied access to the Supplemental Nutrition Assistance Program (SNAP). In 2012, he voted against limiting eligibility and bonuses for SNAP in the Senate Amendments 2172 and 2165. He has spoken out against the reduction of food stamps: “At a time when the richest people in this country are becoming richer and the middle class is disappearing, it is beyond shameful to cut food programs and nutrition programs.”

Take a step back. How has income inequality changed over the years?

Income inequality is the highest it’s been since the Great Depression.  Currently, 0.3 percent of the wealth is owned by the bottom 40 percent of Americans, while 84 percent of the wealth is in the hands of the top 20 percent. This impact is also felt in the federal minimum wage, which, according to the Pew Research Center, was at its highest in 1968 at $8.54 (in 2014 dollars). With these figures, it’s hard to imagine anyone making minimum wage and working full-time to cover their basic needs—like food. Just take a look at this sample monthly budget McDonald’s suggested to its employees in 2013.

ratio-of-household-wealth-to-nation

Historical distribution of wealth in the United States.

But should we really be spending money on SNAP programs? I mean, what about fixing the budget and addressing our deficit?

During the 2015 fiscal year, 53.71 percent of discretionary spending went to the military, which amounts to $598.49 billion. Compare that to the $76 billion allocated to SNAP in 2014. Then consider estimates that 25 percent of millionaires pay less taxes than the middle-class. A recent study showed how lowering taxes for the wealthy can affect the economic status of a country.

FY 2015 Discretionary Budget from the National Priorities Project.

So, who receives food stamps?

While there may be some who take advantage of SNAP, about 45 percent of all recipients are children. You care about kids, right? Well, the SNAP for Women, Infants, and Children (WIC) is an essential program that leads to healthier infants, more nutritious diets, and better healthcare for children. Additionally, disabled individuals make up 19.8 percent, senior citizens count for 8 percent while adults without children who are not disabled make up for 23.6 percent. In other words, these are your neighbors.

But don’t people on food stamps just buy junk food and cigarettes?

SNAP beneficiaries are only allowed to buy household foods and seeds for gardening. Meaning, they cannot buy: alcohol, cigarettes, tobacco, non-food items, supplements, medicines, hot foods, and restaurant or fast-food meals. In many cases, for those who live in a poverty-stricken area, access to fresh produce is limited. Though the trend is changing thanks to some progressive entrepreneurs, it still remains a concerning issue.

What about WIC?  Why do we need that too?

The WIC program is specifically designed for women, infants and children who need nutritional and food aid.  There have been numerous studies suggesting that the health of an individual begins in the fetal and childhood developmental stages. Pregnant women need more vitamins and minerals than the average person. If a mother does not get adequate nutrients in her body, adverse health effects can occur. If there are any deficiencies in a pregnant woman’s diet, her baby will be more susceptible to slow growth, neurological disorders, and even death. On top of infant development, child nutrition is equally important, often influencing a person’s health well into adulthood.

For more on WIC, see here.

But I work hard. Why should I care about SNAP and WIC?

Funding programs like SNAP and WIC is a moral issue. How a nation treats its less fortunate citizens says a lot about a country. Should a great nation like America only worry about the bottom line? Is our nation so consumed with money that we cannot stop to help those in need? The poor should not be neglected or exploited.

Agreed. So, what does Bernie have to say about it?

Addressing relentless attempts to cut back on these nutrition programs, Bernie said, “It is unconscionable that the federal government would cut back on food and nutrition assistance to states as our nation struggles to recover from the worst recession since the Great Depression.”

And in an online interview he addressed the fact that there are “about 46 and a half million people in America living in poverty. Many people have experienced lower wages. People are working 40/50 hours a week. They’re living in poverty,” while, “22 percent of our children are living in poverty.”

So, why Bernie? Couldn’t someone else do a better job?

Bernie has consistently spoken out against the unfair economic climate for those who do not have the means to fully provide food for themselves or their family. He has spoken out against decreasing funding for SNAP while economic disparity rises. On June 2015, Bernie introduced legislation that would, “increase estate tax rates on the top three-tenths of one percent of Americans who inherit more than $3.5 million, while eliminating loopholes that have allowed the wealthiest Americans to avoid billions in taxes.”

For more info on how he is battling economic inequality, click here.