SANDERS: No one is tearing this up, we're going to go forward. But with the secretary neglected to mention, not just the 29 million still have no health insurance, that even more are underinsured with huge copayments and deductibles.

Tell me why we are spending almost three times more than the British, who guarantee health care to all of their people? Fifty percent more than the French, more than the Canadians. The vision from FDR and Harry Truman was health care for all people as a right in a cost-effective way.

We're not going to tear up the Affordable Care Act. I helped write it. But we are going to move on top of that to a Medicaid-for- all system.

Hillary Clinton told a group of her top fundraisers Thursday that if she is elected president, her nominees to the Supreme Court will have to share her belief that the court's 2010 Citizens United decision must be overturned, according to people who heard her remarks.

Clinton's emphatic opposition to the ruling, which allowed corporations and unions to spend unlimited sums on independent political activity, garnered the strongest applause of the afternoon from the more than 200 party financiers gathered in Brooklyn for a closed-door briefing from the Democratic candidate and her senior aides, according to some of those present.

"She got major applause when she said would not name anybody to the Supreme Court unless she has assurances that they would overturn" the decision, said one attendee, who, like others, requested anonymity to describe the private session.

If the make-up of the court does not change by 2017, four of the justices will be 78 years of age or older by the time the next president is inaugurated.

So single-payer advocates looked instead to make a breakthrough in the states. Bills have been introduced from Hawaii to New York; former Medicare chief Don Berwick made it a key plank of his unsuccessful primary race for Massachusetts governor.

Vermont under Shumlin became the most visible trailblazer. Until Wednesday, when the governor admitted what critics had said all along: He couldn’t pay for it.

“It is not the right time for Vermont” to pass a single-payer system, Shumlin acknowledged in a public statement ending his signature initiative. He concluded the 11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of individuals’ income “might hurt our economy.”

Vermont’s outcome is a “small speed bump,” said New York Assembly member Richard Gottfried, who’s been pushing single-payer bills for more than 20 years. But opponents says it’s the end of the road.

“If cobalt blue Vermont couldn’t find a way to make single-payer happen, then it’s very unlikely that any other state will,” said Jack Mozloom, spokesman for the National Federation of Independent Business.

“There will never be a good time for a massive tax increase on employers and consumers in Vermont, so they should abandon that silly idea now and get serious,” Mozloom added.
Read more: http://www.politico.com/story/2014/12/single-payer-vermont-113711#ixzz3xdKH1mGn

On health care: leave on one side the virtual impossibility of achieving single-payer. Beyond the politics, the Sanders “plan” isn’t just lacking in detail; as Ezra Klein notes, it both promises more comprehensive coverage than Medicare or for that matter single-payer systems in other countries, and assumes huge cost savings that are at best unlikely given that kind of generosity. This lets Sanders claim that he could make it work with much lower middle-class taxes than would probably be needed in practice.

To be harsh but accurate: the Sanders health plan looks a little bit like a standard Republican tax-cut plan, which relies on fantasies about huge supply-side effects to make the numbers supposedly add up. Only a little bit: after all, this is a plan seeking to provide health care, not lavish windfalls on the rich — and single-payer really does save money, whereas there’s no evidence that tax cuts deliver growth. Still, it’s not the kind of brave truth-telling the Sanders campaign pitch might have led you to expect.

The Bernie Sanders health care plan, which the Vermont senator released this week, sounds pretty spectacular at first blush. It’s a proposal to create a single-payer system, which means that Sanders would wipe away existing insurance arrangements and replace them with a single government program. Everybody would get insurance, free of co-pays or deductibles.

That’d be an upgrade in benefits, even for seniors on Medicare. And while people would have to pay higher taxes, Sanders claims most people would come out ahead financially because they wouldn’t be paying private insurance premiums anymore. A typical middle-class family would save about $5,000 a year, according to a rough analysis commissioned by Sanders' presidential campaign, while society as a whole would end up saving something like $6 trillion over the next decade.

To help pay for his plan’s unprecedented benefits, Sanders proposes to extract unprecedented savings from the health care system. Here is where the details get fuzzy and hard to accept at face value, even beyond the usual optimistic assumptions that figure into campaign proposals. Sanders expects a large portion of the savings to come from reductions in administrative waste, because insurance billing would basically end. Another big chunk would come from squeezing the industries that produce health care services and supplies -- and squeezing those industries hard.

That last part should set off alarm bells for anybody who remembers the fight to pass the Affordable Care Act. Two particular episodes from 2009 -- one widely publicized, one barely noticed -- are a reminder of how much power those groups wield in Washington. For Sanders to realize his vision for single-payer health care, he’d have to overcome even greater resistance than Obamacare’s architects faced. And Sanders has offered no reason to think he could do that, which is something Democratic voters might want to keep in mind.

Two lessons from Obamacare

The first and better-known episode from 2009 was the battle over the “public option” -- a proposal, crafted by Yale political scientist Jacob Hacker, to create a government-run insurance plan that would compete with private insurers for customers. Hacker and others figured the public option could dictate lower payment rates to suppliers and providers of medical care, just like Medicare does, thereby keeping premiums low and forcing private insurers to match them.

Voters liked the idea, according to polls, and experts had certified that it would save the government money. But it ran into huge opposition -- not just from insurers, who didn’t want the competition, but from doctors, makers of drugs and medical devices, and hospitals, all of whom understood the proposal would cut into their revenues....

Bernie's vision vs. Hillary's

No, this grim political reality doesn’t mean Sanders or anybody else should stop advocating for single-payer. Progressive achievements like the minimum wage and civil rights began as ideas that the political establishment once dismissed as loopy. And the kind of reform that Sanders envisions would have a lot going for it. Single-payer works quite well abroad and a version of it could work here too -- even if, as Harold Pollack and Matthew Yglesias noted recently at Vox, it would ultimately require compromises and trade-offs that supporters rarely acknowledge.

But voters comparing Sanders and Hillary Clinton, who has proposed bolstering the Affordable Care Act rather than replacing it, should be clear about the choice they face. This isn’t a contest between a candidate who can deliver health care nirvana and one who is willing to settle for less. It’s a contest between a candidate imagining a world without political or policy constraints, and one grappling with them; between a candidate talking about what he hopes the health care system will look like someday, and one focused on what she can actually achieve now.