Politics and Health Care, What a Mix, or a Mix-up!

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As I was watching the Iowa primaries and the media spin I wondered whether the health care discussion could have influenced the voters. What a farce though with the Democratic choice being determined by the flip of 7 coins. What is the statistical chance of all coin flips coming up for Hillary, all seven. The odds of that happening are 1 in 64, or less than 2 percent for 6 flips. What’s more, that gave her just slightly more than her margin of victory over Sanders — four delegates. If that is really true, Hillary needs to play the lottery, the Powerball even. Oh, wait she is already winning the lottery getting paid $275,000 -675,000 per speech. This doesn’t seem right, especially where she is getting these “invitations from……her buddies in Wall Street.

That is progressive….she has made a great deal of progress from when she declared her and Bill broke to now being worth many millions of dollars. I repeat, it all doesn’t seem right!

Harris Meyer wrote that after attacking Donald Trump over the weekend for his previous favorable remarks about single-payer healthcare, Texas Sen. Ted Cruz squeaked out a victory over the billionaire New York developer in the Iowa presidential caucuses Monday night, with Florida Sen. Marco Rubio trailing close behind.

As I mentioned, the Iowa Democratic Party declared Hillary Clinton the narrow winner over Vermont Sen. Bernie Sanders in their unexpectedly tough contest for the Democratic nomination, though Sanders had not conceded early Tuesday morning. Former Maryland Gov. Martin O’Malley dropped out of the race after winning only a tiny proportion of the caucus votes. Unlike Sanders’ support for single-payer national health insurance, O’Malley’s advocacy for a system like Maryland’s featuring a global budget for hospital spending gained little traction with Iowa Democrats.

Rubio’s strong third-place finish positions him well for the Feb. 9 presidential primary in New Hampshire, where GOP voters tend to favor more mainstream conservatives, though Trump has led the polls there for months. Cruz is expected to do better in the Feb. 20 primary in South Carolina, where a high percentage of Republican voters are evangelical Christians, as in Iowa.

Republican presidential hopefuls Jeb Bush, Chris Christie, and John Kasich won small shares of the Iowa caucus votes, and will have to do well in New Hampshire to save their candidacies.

It’s unclear whether healthcare policy issues played a role in the GOP caucus results, but some observers believe Sanders’ support for single-payer helped him energize his supporters in the Democratic race.

Most of the Republican candidates have said little about healthcare during the campaign so far other than denouncing the Affordable Care Act and calling for its repeal.

Douglas Gross, a Republican attorney in Des Moines who headed Mitt Romney’s Iowa presidential campaign in 2008, predicted that his state’s caucus outcomes would leave the healthcare policy discussion unchanged in the 2016 campaign. “Rubio and Cruz would like to repeal Obamacare, but they haven’t accomplished it and they don’t have a specific alternative that’s likely to pass,” Gross said. “And the Democrats are resolved to defend Obamacare. That means there won’t be much change. And I don’t see the policy discussion becoming any more detailed.”

Cruz offered slightly more detail last week, saying he wants to “delink health insurance from employment, so if you lose your job, your health insurance goes with you, and it is personal, portable and affordable.” He cited three pet conservative reforms he favors—allowing insurers to sell plans across state lines, expanding health savings accounts, and severing the link between coverage and employment. The problem is that he offers no way to maintain the ACA’s coverage expansion if he abolishes the law.

Indeed, on Saturday an Iowa voter challenged Cruz with a story about how his brother-in-law was only able to afford health insurance after the ACA took effect. He twice asked Cruz what he would replace the law with. Cruz replied with his standard proposal for expanding health savings accounts and allowing insurers to sell plans across state lines.

Cruz said, “Donald Trump and Hillary Clinton and Bernie Sanders have the identical position on health care, which is they want to put the government in charge of you and your doctor.”

While Trump, Clinton and Sanders have all proposed to reduce prescription drug prices, that one policy is a far cry from having “the identical position on health care.” Cruz’s description of that position (putting the government in charge of you and your doctor) can only reasonably be applied to Sanders’ single-payer system.

Clinton has proposed specific ways to defend and expand Obama’s health care law. Trump, whose exact plan is unclear, has said repeatedly that he’d repeal and replace Obamacare with a market-based alternative.

To suggest that Trump, Clinton and Sanders have the same health care proposal is inaccurate. There are many specific differences between the three plans. We rate Cruz’s statement False.

Over the weekend, Trump said he strongly opposes Obamacare and rejects a single-payer system. But when asked how his healthcare proposal differs from the ACA, Trump said, “I want people taken care of” and that he would “work something out” after abolishing the ACA. “We’re going to work with our hospitals. We’re going to work with our doctors. We’ve got to do something … I have a heart.”

Rubio last summer laid out a brief healthcare proposal centered on offering a refundable tax credit to help people buy health insurance, with a gradual reduction in the tax exclusion for employer health plans. In addition, he would establish federally funded high-risk pools to cover people with pre-existing conditions, let insurers sell plans across state lines, and expand health savings accounts. Plus, he promised to shift Medicare into a defined-contribution, “premium-support” system and convert Medicaid into a capped state block grant program.

On the Democratic side, there has been a spirited healthcare policy debate between Clinton and Sanders, with Clinton favoring fixes to the ACA to reduce consumers’ out-of-pocket and drug costs and Sanders advocating a tax-supported single-payer system with no premiums, deductibles or cost-sharing.

Pundits are questioning the political wisdom of Democratic presidential candidate Hillary Clinton’s attacks against her rival, Vermont Sen. Bernie Sanders, over his proposal for a Medicare-for-all, single-payer health insurance system in the U.S.

There’s good reason for those questions. Conversations this month with Democratic Party officials and voters in Iowa lend support to comments that Clinton’s assault on Sanders over single payer is a risky gambit going into that state’s Feb. 1 presidential caucuses.

A recent Kaiser Family Foundation poll found that 81% of Democrats favor a Medicare-for-all approach, and nearly 1 in 5 Democrats said healthcare was their top issue, according to a recent Washington Post/ABC News poll. It’s hard to have a conversation about healthcare with people who identify as Democrats or liberals without hearing laments that single payer would be better than the Affordable Care Act.

Polls show Sanders and Clinton in a neck-and-neck race to win the Iowa caucus contest, the nation’s first presidential primary contest. In their televised debate Sunday, they almost certainly will face off on the merits of Clinton’s approach of “fixing the glitches” in the ACA versus Sanders’ proposal to replace it with a government single-payer system.

“People would like single payer,” Dr. Andy McGuire, who chairs the Iowa Democratic Party, said in an interview. “I think it’s more the realization that it’s difficult to get to single payer. For practical reasons, fixing the ACA is what people talk about.”

“I think the dominant position is to improve the ACA,” said Democratic state Sen. Rob Hogg, who hopes to run against Republican U.S. Sen. Chuck Grassley in November and who takes that “fix-the-glitches” stance. “But on the Democratic side there is still a significant reservoir of people pushing for a single-payer system.”

On Wednesday, the Clinton campaign launched a major assault through surrogates, including the candidate’s daughter Chelsea, on Sanders’ single-payer proposal. Clinton and her allies criticize Sanders for not saying how he would pay for a single-payer system. They argue that adopting such a system would impose heavy taxes on middle-income Americans. Clinton doesn’t acknowledge that the taxes people would pay for national health insurance would replace premiums they and their employers currently pay for private insurance, offsetting the cost.

Sanders has not released a detailed single-payer proposal. On Wednesday, his campaign issued a fact sheet on how he would pay for various programs but did not address financing his healthcare plan. Sanders promised to release his financing plan before the Feb. 1 Iowa caucuses, but his campaign manager subsequently said he may miss that deadline.

The Sanders campaign has counterattacked by accusing Clinton of using “Karl Rove tactics” to demonize the concept of national health insurance, referring to the well-known GOP political strategist.

The Sanders campaign distributed a video of Clinton’s 2008 response during her nomination battle with Barack Obama to Obama’s attacks on her proposal to require everyone to buy health insurance. “Since when do Democrats attack one another on universal healthcare?” she said at the time.

Clinton may be hoping to raise doubts in the minds of Democratic primary voters about Sanders’ electability as a self-proclaimed democratic socialist. Her attacks on his single-payer proposal may prompt Democrats to recognize that if he’s nominated, Republican attacks on his healthcare plan and its associated taxes will be much more intense.

But Iowa Democrats may be offended by her fierce rejection of a national health insurance model many of them prefer over Obamacare—and which Clinton herself favored in the distant past.

Sanders seemed to win substantial liberal support in Iowa with his single-payer stand, though some liberal analysts questioned the political and economic viability of his proposal. It remains to be seen how much appeal his single-payer stance will have in New Hampshire and South Carolina, where Democrats may be less enthusiastic about a plan that would require significant new taxes on middle-income households.

Democratic state Sen. Rob Hogg of Cedar Rapids said Iowa Democratic voters, like Clinton and Sanders, have “differing visions” of how to proceed on healthcare, though he doesn’t think that was the dominant reason causing people to vote the way they did. “But what I do see from Democrats is a strong desire to move forward on a healthcare system that covers more people and not to go backward,” he said.

I will get more into an evaluation of Hillary’s ideas on health care in another post.

But I pose final questions, are we becoming immune to the real problems that politics forces upon us all and when are we as educated voters going to reach our tipping points? I think that this is part of the reason that such ridiculous candidates for the highest office in our Country have such high polling numbers.

I will continue to ask these questions and hopefully we will develop our own answers to the health care conundrum.

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