February 4, 2016

AS MILLIONS of people struggle to access health care and fall through the cracks of the Affordable Care Act (ACA), a.k.a. Obamacare, the Hillary Clinton campaign is adding its own confusion and fear to the election-year mix.

Clinton's daughter Chelsea fired some of the first shots at Bernie Sanders for supporting universal, single-payer health care, telling a New Hampshire audience in January, "Sen. Sanders wants to dismantle Obamacare, dismantle the CHIP program, dismantle Medicare and dismantle private insurance."

"I don't want to live in a country that has an unequal health care system again," she added.

It's hard to know exactly where to start in unraveling such dishonesty.

For one thing, as Sanders himself acknowledges, he helped write parts of the ACA and voted for the final legislation, in spite of how far short it fell from providing universal coverage, much less affordable care.

But what's even more deceptive about the Clinton campaign scaremongering is the idea that the single-payer system which Sanders endorses is somehow inferior to Obamacare.

Hillary Clinton

A single-payer system, also called Medicare for all, would guarantee health care for every person throughout their whole life. Single-payer wouldn't "dismantle Medicare," but expand this popular health care program for seniors to cover everyone.

What single-payer would dismantle, if carried out consistently, is the stranglehold of the private insurance industry over the current health care system.

Sanders' campaign platform on health care isn't specific about how he would deliver single-payer health care or the role that the private sector might still play in such a system. One of the complaints of people who live under a universal health care system--which includes virtually all developed countries other than the U.S.--is that private companies have been allowed to chip away at once superior benefits.

But Sanders just mentioning the words "Medicare for all" got Clinton supporters worked up. The fact that the Clinton campaign wheeled out the candidate's daughter to spread misinformation about Sanders' position reveals the heat Clinton must be feeling as a significant number of voters reject her lower-your-expectations message.

Hillary Clinton, who previously touted her legacy in spearheading Bill Clinton's failed health care initiative in 1993--a more advanced reform than Obamacare turned out to be, in fact--now argues against a plan that would actually provide health care to every American. And she's doing it by raising fears that even proposing single-payer health care would imperil all the "hard work" done to put Obamacare in place.

Just talking about single-payer seems to be a problem to the Clinton campaign. "I would underscore that to put this country back into that debate on health care is to put all of the progress that we've made on the Affordable Care Act" at risk, Clinton campaign senior policy adviser Jake Sullivan told Politico.

Meanwhile, the millions of people who actually have to deal with the ACA face obstacles at every step of the way, particularly the working-class people that the Obama administration claimed it was aiming to help.

DESPITE WHAT Republicans insist, Obamacare is nowhere near "socialized medicine."

While portions of the ACA made welcome improvements--for instance, banning the previous practice of denying coverage to people with pre-existing conditions and providing subsidies for low-income people--the ACA doesn't come close to covering all the millions of people who need health care. In fact, for many working-class people, the new system has made things worse.

The insurance exchanges, where the uninsured must navigate a morass of expensive private insurance plans with high deductibles and long lists of restrictions, are forcing people into plans with meager coverage that nevertheless take a bigger chunk out of their pocketbooks than they were told.

And according to a recent study by the 538.org, some 33 million people in the U.S. still don't have health insurance.

The other shoe drops this year because this is the cut-off for individuals to prove they're covered by some kind of insurance or they will face penalties according to the "individual mandate" in the ACA. Individuals who don't have health coverage and don't qualify for exemptions from the mandate could owe the IRS between $695 and more than $2,000.

When the ACA passed, some argued that it wasn't as good as single-payer, but it was better than nothing--and it would be a springboard toward something better. But the opposite has been the case--the ACA has further entrenched the role of the private insurance industry in offering coverage that is more expensive and less accessible.

Any health care initiative with the goal of covering every American would have to start by taking insurance company profits out of the equation.

Cutting the complex administrative costs of for-profit health care alone would make a huge impact. As Steffie Woolhandler of Physicians for a National Health Program explained in a recent interview for CounterSpin, "The U.S. spends 31 cents on every health care dollar on billing and administration; Canada spends about 16.5 percent.

"That's a very large difference in terms of administrative spending. Projected to the U.S., we could say that a single-payer system would save over $400 billion a year in administrative costs, and that's the money that you use to pay for expanded care, both for the uninsured and for people who now have only partial coverage."

During the 1993 health care debate, Hillary Clinton met with single-payer activists, including Woolhandler, and said she favored their proposal, but thought it was impractical. Today, she's painting single-payer as an assault on Obamacare.

IN 2016, as in 1993, Clinton's real problem with single-payer comes down to one thing: health care industry profits.

Like many of the establishment candidates in this year's election, Clinton receives a lot of backing from the insurance industry. According to data compiled by the Center for Responsive Politics, over her career, Clinton has taken in $13.2 million from sources in the health sector--$11.2 million as a senator and $2 million from health industry sources during her 2016 presidential campaign.

The Washington Post revealed its real concern about single-payer when it re-enforced Clinton's smears against Sanders and single-payer in several recent articles. The Post questioned his lack of "political realism"--for example, "his dubious choice to tap the rich for huge amounts of revenue and spend it all."

For his part, Sanders doesn't have any insurance company backers, and he's raising people's expectations about the potential for a health care plan that works for everyone. At the same time, though, he's shown his willingness to support the "reasonable position" on health care--and settle for something that falls far short of what people need.

During the congressional debate on health care in 2009, Sanders threatened to oppose any legislation it didn't include at least a "public option"--a much-watered-down and compromised alternative to single-payer that would, nonetheless, at least give people an alternative to overpriced private insurance.

But then the Obama administration bargained away the public option, too, in a vain attempt to appease Republican opposition in Congress. Many Democrats argued that the resulting legislation, while flawed, was all that could be accomplished, and every vote would be needed to get the ACA past the Republicans. And so single-payer advocates like Sanders and liberal Democrat Dennis Kucinich went along and voted yes.

Since then, much more has been compromised away on the ACA, including one of the most significant positive provisions--an expansion of the Medicaid program for low-income people. In 2012, the U.S. Supreme Court struck down that part of the law, allowing states to opt out of the Medicaid expansion. Governors in some 25 states, including some of the country's poorest, are now denying the expanded coverage, with a terrible impact on the people that need health care coverage the most.

Despite the drumbeat to the contrary, in polls, single-payer health care gets support. A December poll by Kaiser Health Tracking reported, "When asked their opinion, nearly 6 in 10 Americans (58 percent) say they favor the idea of Medicare for all, including 34 percent who say they strongly favor it."

But in this election, single-payer is being portrayed by the political establishment and its media echo chamber as unrealistic idea, one too far-fetched to even consider.

What's really unrealistic and far-fetched is propping up a health care system that guarantees huge profits for the private health care industry while denying the rest of us access to the health care we need.