What You Need To Know About Hillary Clinton’s Attack On Single-Payer Health Care

Democratic presidential candidate Hillary Clinton speaks during a campaign event at Iowa State University in Ames, Iowa, Tuesday, Jan. 12, 2016. CREDIT: AP PHOTO/PATRICK SEMANSKY
Democratic presidential candidate Hillary Clinton speaks during a campaign event at Iowa State University in Ames, Iowa, Tuesday, Jan. 12, 2016. CREDIT: AP PHOTO/PATRICK SEMANSKY

As the race tightens between the two leading Democratic presidential candidates, they’re engaged in a fierce policy battle over a key progressive issue: access to health care.

The Hillary Clinton campaign is amping up its attacks on fellow presidential candidate Bernie Sanders’ health care plan, saying it’s a “risky deal” that could return the country to an era when “millions and millions and millions of people” did not have access to insurance. The Sanders campaign, meanwhile, is working to highlight the apparent hypocrisy here — pointing out that Clinton has a history of supporting universal health care, and once said that Democrats attacking each other’s health care plans “undermined core Democratic values.”

Here’s what you need to know about the policy dispute:

Sanders wants health care for all, but his plan is thin on details.

Sanders has long advocated what’s known as a “single-payer system,” in which one government program would offer insurance to Americans without charging the premiums, deductibles, or co-pays that currently finance the private insurance sector.


This policy is sometimes referred to as “Medicare for all” because it would, in many ways, extend the current system that’s in place for Medicare beneficiaries to everyone else in the country. The general idea behind this model is that the government would raise health care taxes to pay for the cost of extending insurance to everyone.

In 2013, Sanders introduced a bill in Congress seeking to enact a “Medicare-for-All Single Payer Health Care System” that tracks closely with his current proposal. But so far, the Sanders campaign has not released specific details about how he would pay for his plan. That makes it difficult for industry experts to assess how it might work in practice.

Clinton is using dishonest arguments against single-payer health care.

This week, the Clinton camp has been repeating an argument against Bernie’s plan that amounts to an unfair characterization of how universal health care actually works. Clinton argues that Bernie wants to “take everything we currently know as health care, Medicare, Medicaid, the CHIP Program, private insurance, now of the Affordable Care Act, and roll it together” — suggesting that could cause millions of people to lose their health insurance.

It’s true that a single-payer system would replace all of the different types of insurance that we have now, and it’s true that Americans would initially have to shift to new plans. But that’s not a problem with Sanders’ proposal — it’s actually the whole point. Proponents of universal health care argue it will be more efficient and more equitable for the government to administer one centralized health care program.


“If anything, a single-payer plan like the one Sanders envisions would result in more coverage than current arrangements would allow,” the Huffington Post’s Amanda Terkel and Jonathan Cohn point out. That’s because, while there are still people who remain uninsured under Obamacare because they haven’t signed up for a plan, a Medicare-for-all system would treat insurance like a public good and require states to automatically enroll their residents in plans.

Clinton also argues that Sanders’ plan would result in a massive tax hike for the middle class. While it’s true that a single-payer system would necessitate a big raise in taxes, this is a misleading way to frame it. Clinton doesn’t include that fact that Sanders would also eliminate the health care costs currently plaguing Americans in the form of premiums, deductibles, and co-pays.

The health care landscape has changed a lot since the passage of Obamacare.

Hillary Clinton has experience trying to pass health care reform in a contentious political environment, going toe-to-toe with the insurance companies that eventually torpedoed the 1993 legislation she supported. Why, then, would she want to attack a populist vision of health insurance in a way that may protect those insurers’ power?

The landscape has changed considerably since the passage of President Obama’s landmark health care reform law. In order to ensure Obamacare’s success, Democrats had to partner with the health insurance industry and figure out ways to make reform benefit hospitals’ and insurers’ bottom lines. Now, as Democratic politicians are invested in preventing Republicans from rolling back the gains under the health law, the insurance industry has become somehow of an ally.

Clinton is no exception. Insurance companies know that, thanks to Obamacare, there’s a lot at stake for them depending on who takes over the White House — so they’ve been building connections to Clinton’s campaign. During this week’s dust-up, observers have been quick to point out that Hillary’s line of attack makes sense considering the money she now receives from the insurance industry.

Sanders’ home state hasn’t figured out how to make single-payer work.

The health care conflict between Clinton and Sanders draws out familiar battle lines between a more pragmatic and a more leftist approach to governing.


Clinton has long been skeptical of single-payer’s political viability, pointing out that Americans are fearful of anything that can be construed as “socialized medicine.” There’s some evidence that she’s been privately supportive of the single-payer model. But she clearly isn’t hopeful about getting it through Congress and isn’t willing to attach herself to this particular policy.

There’s no denying the challenges. Even in Sanders’ home state, where there was a lot of political support for opting out of Obamacare and enacting a version of single-payer, local lawmakers couldn’t get it done. After three years of working toward the first universal health care system in the country, they said they couldn’t figure out how to pay for it (though some economists took issue with the governor’s estimate of the plan’s $3 billion price tag).

When PolitiFact set out to assess Bernie Sanders’ health plan this week, multiple experts gave cautious responses about the senator’s proposed policy that echo the recent experience in Vermont. They said it’s unclear how much it will cost and it’s unlikely lawmakers would pass it.

Health care is a key issue for progressive voters.

For years, grassroots activists calling for universal health care have influenced the Left’s thinking on this issue — and made progress in branding insurance as a basic human right.

Now, this issue could have ripple effects throughout the presidential primary. Single-payer is a fairly popular policy among Democratic voters. According to the Kaiser Family Foundation, self-identified Democrats either strongly favor (52 percent) or somewhat favor (24 percent) the general idea of creating a government-run health care program to insure all Americans.