When Democratic Party voters cast their ballots in New Hampshire today, many of them will be doing so under the crushing weight of the current health care system. New Hampshire has been severely ravaged by the opiate crisis, and its Medicaid system has been under attack by the State House and Donald Trump. Residents know firsthand how cruel and inefficient the private, multi-payer system can be.

Sen. Bernie Sanders, who leads polls in New Hampshire, is unique among the candidates in maintaining unambiguous support for the full and immediate implementation of Medicare for All. His argument that health care is a human right is a central part of his stump speech. Sen. Elizabeth Warren also supports Medicare for All, but her plan splits its implementation into a two-stage process involving two separate bills: The first bill would introduce a public option bill much like the ones offered by other candidates. She then plans to pass an entirely separate piece of legislation in year three that would be a true single-payer plan. Some analysts have interpreted this two-part strategy as a sign of wavering support for the policy, while others see it as strategic. Pete Buttigieg supported Medicare for All until the insurance industry started funding his campaign, at which point he started calling the plan “dangerous,” and proposed an optional plan for citizens to buy in to Medicare. Other candidates like Joe Biden have been outright attacking the idea from the start of the campaign.

Polls show that New Hampshire primary voters consider health care to be the most important issue in the election. This was true in Iowa and is also a national trend. Sanders is reliably listed as the most trusted candidate on health care among Democrats in New Hampshire and beyond. The corporate media dogmatically argues single payer is a political liability for Democrats, but polls have long shown majority support for the policy, including overwhelming support among Democratic voters.

Thus, it’s no surprise that Medicare for All advocacy has fueled much of the energy behind Sanders, whose viability as a national candidate has given advocates for a single-payer health care system a major voice in the national debate for the first time in a generation.

“People in New Hampshire are really sick of having to deal with such an ugly health care system — a system that is about providing profits to corporations at the expense of the working class and the poor,” said James Haslam, director of Rights and Democracy, a New Hampshire-based organization aimed at countering the influence of money in politics. “This is what is energizing many people in New Hampshire around the Bernie Sanders campaign…. [It’s] about his message that health care is a human right.”

How the Health Care Crisis Has Hit New Hampshire

The Granite State has struggled for years thanks to the gross inequities of American health care, Haslam tells Truthout. “The opiate overdose epidemic has hit the state hard,” he said.

New Hampshire has one of the highest overdose rates in the country. Rural areas already deal with disadvantages in funding health care and providing access to low-population centers. Medical researchers have noted the “substantial challenges to public health in New England’s rural states, where access to pharmacotherapy for opioid use disorder (OUD), harm reduction, HIV and hepatitis C virus (HCV) services vary widely.” Like much of the U.S., New Hampshire still has a long way to go in providing access to the most effective medicines to counter opiate abuse disorder, though the state has made progress in trying to widen access to medication.

Polls show that New Hampshire primary voters consider health care to be the most important issue in the election.

“The evidence is clear that people taking [medication] have better outcomes,” said Henry Klementowicz, staff attorney at ACLU of New Hampshire, in an interview with local New Hampshire media.

Yet patients face financial obstacles to receiving care. Existing safety net programs like Medicaid have been attacked in New Hampshire. At the urging of Trump’s team at the Centers for Medicare and Medicaid Services, the state introduced Granite Advantage, which throws thousands of New Hampshire residents off Medicaid with stricter means testing (evaluations to determine financial eligibility). This Trump-led war on Medicare is being pursued in a dozen states. So far Granite Advantage has been stopped by James Boasberg of the Washington D.C. district court, but more litigation is on the way. If implemented, Granite Advantage could throw 15,000 people earning below or near-poverty wages off Medicaid. Many of those people will likely be eligible for assistance, but will be thrown off because of administrative errors and lost paperwork.

This is a key problem with means testing: It enables regressive tweaks to eligibility to be weaponized against patients. Meanwhile, the paperwork it takes to deprive people of health care is a substantial cost. New Hampshire ranks fourth in health spending per capita and these costs would likely rise should Granite Advantage become law. These administrative costs are a uniquely American problem. Administrative spending in the U.S. health system far exceeds similar spending in other wealthy nations, according to the Annals of Internal Medicine.

Means–tested plans are, by definition, not universal. In a universal program, one doesn’t have to go through a process to prove they can’t afford care. Instead, one is generally automatically enrolled and subject to the same basic paperwork requirements as every other citizen.

These administrative savings do not exist in public option plans, such as Buttigieg’s “Medicare for All Who Want It.” This distinction matters to many voters.

“[We] cannot afford to have a system that is geared to allow insurance companies and the pharmaceutical industry to [profit…] while tens of millions of Americans are uninsured,” says Sharlene Hammond-Labore, a resident of Manchester, New Hampshire, and co-chair of the Rights & Democracy board.



Medicare for All’s Winning Argument

When Bernie Sanders and Elizabeth Warren make the case for Medicare for All, they run into a predictable counterargument: They are always asked about the costs of the program, even though the policy saves money over the status quo when all factors are taken into account. When Joe Biden and others attack Medicare for All on costs, they often cite the number $32 trillion.

What they fail to mention is that this $32 trillion is the cost of single-payer health care over a 10-year period and is $2 trillion less than what would be spent under the status quo. They also fail to mention it is the study least favorable to single-payer, conducted by the Mercatus Institute, a Koch-funded free-market think tank. Other studies, such as those carried out by the Political Economy Research Institute at UMass Amherst, show greater savings, as do the case studies across the world. The average nation with single-payer or something like it spends a little more than half of what the U.S. spends on health care.

Yet while the economic argument favors those who support Medicare for All, that argument is not the reason the policy resonates with so many voters. Yes, Medicare for All is efficient and less expensive to operate, but more than that, people believe that health care should be a human right – for themselves and for others.

Medicare for All is efficient and less expensive to operate , but more than that, people believe that health care should be a human right.

Sanders seems to increasingly understand this. “He just makes the basic compelling point captured by that chart — America’s health care system is bizarrely terrible, providing less coverage at greater cost than what we see in comparable countries,” wrote Matt Yglesias in the center/liberal outlet Vox.

Elizabeth Warren has also endorsed Medicare for All but has proposed a public option plan to be passed before any Medicare for All bills. This more measured strategy may be strategic in relation to establishment concerns but also risks capturing less of the public imagination. Heading into New Hampshire, Warren is predicted to finish in third or fourth place in a state that is right next to her home state of Massachusetts. However, Warren’s support for some form of single-payer has played a role in elevating the issue as a clear progressive priority in the 2020 election.

Indeed, going into today’s primary, many New Hampshire voters have health care at the top of their minds as they’re choosing a candidate.

“It is the moral argument that resonates in New Hampshire and everywhere else,” Haslam said. “It is wrong not to provide health care to people when they need it.”



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