“Medicare for all” price tag.

In May 2016, The Urban Institute, not known as being a bastion of free market thought, released their best cost estimates for Bernie style “Medicare for all.”

Below is the executive summary (minus a overview of their methods). You can read the report in its entirety here.

The Sanders Single-Payer Health Care Plan

Presidential candidate Senator Bernie Sanders has called for adopting a single-payer health care system in the United States.1 He proposes replacing the programs established under the Affordable Care Act (ACA), as well as preexisting public programs such as Medicaid and Medicare, with the new system. Under his approach, all individuals in the United States would be covered by a single insurance program. Sanders’s plan would eliminate all private spending and replace all private and public coverage programs, except Veterans Health Insurance and the Indian Health Service. Benefits provided under the insurance plan would cover all medically necessary services, and cost sharing would be eliminated entirely. Coverage would include both acute and long-term care.

Our central findings of the effects of the Sanders approach are shown in table 1 and include the following:

  •   All American residents would be automatically enrolled in acute care coverage, increasing insurance coverage by an estimated 28.3 million people in 2017, from an uninsurance rate for nonelderly adults of 10.4 percent under current law in 2017. In 2026, the Sanders plan would decrease the number of nonelderly uninsured by 30.9 million, or 11.0 percent of the population, relative to current law. (The uninsurance rate under current law in 2026 is projected to be larger than the rate in 2017 as a result of demographic changes and a slight decrease in the rate of employer-sponsored insurance.) Although the intent is unspecified in the campaign’s materials, this finding assumes that the plan would cover the undocumented population as well as citizens and other legal residents.
  •   National health expenditures for acute care for the nonelderly would increase by $412.0 billion (22.9 percent) in 2017. Aggregate spending on acute care services for those otherwise enrolled in Medicare would increase by $38.5 billion (3.8 percent) in 2017. Long-term service and support expenditures would increase by $68.4 billion (28.6 percent) in 2017.
  •   Together, national health expenditures would increase by a total of $518.9 billion (16.9 percent) in 2017, and by 6.6 trillion (16.6 percent) between 2017 and 2026.
  •   The increase in federal expenditures would be considerably larger than the increase in national health expenditures because substantial spending borne by states, employers, and households under current law would shift to the federal government under the Sanders plan. Federal expenditures in 2017 would increase by $1.9 trillion for acute care for the nonelderly, by $465.9 billion for those otherwise enrolled in Medicare, and by $212.1 billion for long-term services and supports.
  •   In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026. The increase in federal spending is so large because the federal government would absorb a substantial amount of current spending by state and local governments, employers, and households. In addition, federal spending would be needed for newly covered individuals, expanded benefits and the elimination of cost sharing for those insured under current law, and the new long-term support and services program.
  •  State and local governments could save $319.8 billion in 2017 and $4.1 trillion between 2017 and 2026 as the federal government absorbs these costs under the Sanders plan (not shown in table 1). A maintenance-of-effort requirement could make state and local funds available to help pay for the plan, but the legality of such a requirement is in question.
  •   Private health care spending by households and employers would drop as the federal government would absorb their spending under current law. Private sector expenditures for these groups would decrease by $1.7 trillion in 2017 and by $21.9 trillion between 2017 and 2026. These considerable savings would partially offset the impact on the private sector of new taxes required to pay for the Sanders plan.
  •   Analysis by the Tax Policy Center indicates that Sanders’s revenue proposals, intended to finance all new health and nonhealth spending, would raise $15.3 trillion in revenue over 2017 to 2026. This amount is approximately $16.6 trillion less than the increased federal cost of his health care plan estimated here. The discrepancy suggests that to fully finance the Sanders approach, additional sources of revenue would have to be identified; that is, the proposed taxes are much too low to fully finance the plan.

Obama The Restrainer?

There is a discussion over at War On The Rocks regarding Obama’s foreign policy legacy.

Paul Miller of the Clements Center for National Security at The University of Texas at Austin argues

…In his [Obama] eagerness to avoid making Bush’s mistakes, he made a whole new set of mistakes. He over-interpreted the recent past, fabricating the myth about a hyper-interventionist establishment. As a result, he overreacted to the situation he inherited in 2009 and, crucially, never adjusted during his eight years in office. In this sense and others, he contrasts starkly with Bush, who made major changes in his second term. The result is that Obama retrenched when he should have engaged. He oversaw the collapse of order across the Middle East and the resurgence of great power rivalry in Europe while mismanaging two wars and reducing America’s military posture abroad to its smallest footprint since World War II. Despite the paeans of Obama’s admirers, this is not a foreign policy legacy future presidents will want to emulate.

Trevor Thrall and John Glaser, both of the CATO institute counter this interpretation, writing

There were many things to dislike about American foreign policy during the Obama years, but too much restraint simply was not one of them. Miller is right to argue that Obama bucked the conventional wisdom in Washington far less often than he himself claimed, but Miller fails to mention that the worst flaws of Obama’s foreign policy — an overreliance on military intervention and overconfidence in the ability of the United States to control political outcomes abroad — were simply carryovers from the Bush administration.

To be sure, Obama was not the one who invaded Afghanistan or Iraq, but he embraced and expanded the global war on terrorism in every other dimension. On his watch, Obama participated in regime change in Libya, ordered a massive increase in a global drone campaign, provided material support to Saudi Arabia in its war in Yemen, and escalated (and later maintained) open-ended nation building and internal defense efforts in Afghanistan. Obama was many things, but a restrainer he was not.

My interpretation of this sort of discussion, which has been ongoing for at least the past 5 years, is that those who argue that Obama was a restrainer are confusing a lack of leadership with a foreign policy ideology. All Presidents must work within the system but no one who subscribes to the restraint outlook on foreign policy would have gotten involved in places like Libya, Syria, Somalia, Pakistan, or Yemen.

Here is Paul’s original essay.

Trevor and John’s response can be found here.

Long reads but highly recommended.

Paul Pillar on America in the Middle East

National Interest has a wonderful article penned by Paul Pillar titled “How Donald Trump Should Transform America’s Middle East Policy.”

He states the quite obvious that

An immense share of the blood and treasure the United States has lost overseas in the past couple of decades has been in the Middle East, an expenditure that has not brought proportionate benefits.

You can rattle off the failures easily, from the Iraq invasion to the dithering in Syria. Obama’s Pivot to Asia, which was based on an interpretation of America being over-involved in the Middle East, was a good start in addressing our poorly formulated regional policy. Yet, a significant chunk of his foreign policy legacy will be defined by his inability to disentangle America from Middle Eastern politics. This includes Libya, Yemen, Syria, ISIL, Iran, the Arab Awakening, Peace Process, etc..

What is to be done? The US still has interests in the Middle East, but they should be better defined and more limited. Moving forward, his recommendations include

…the initial principle that the new administration should observe in making policy toward the region is the Hippocratic one of first doing no harm. A second principle is to keep costs and risks commensurate with prospective gains to U.S. interests. A third is to recognize that not all problems, even heart-rending ones, are solvable, and that if they are, the United States is not always best suited to solve them. Often the interests and objectives of other players in the region are better engaged, and this sometimes means taking advantage of the balancing of conflicting interests.

Highly recommended that you read the entire thing (quickly as it will soon be gated).

 

President Obama’s biggest failures.

At the National Interest, Daniel R. DePetris has a piece where he discusses “…the five biggest failures that will at least partially color President Obama’s two terms..”

The list includes

  1. Guantanamo Remains Open
  2. No Mideast Peace Deal
  3. The Syria Red Line
  4. Partisanship Got Worse
  5. A Nation that Remains At War

It is a curious list as you hear very little about Guantanamo, all Presidents fail at the peace process, Republicans decided on day 1 to oppose every aspect of his agenda, and most civilians don’t feel as if they are at war (I’m not convinced that the average voter is aware or even cares about Obama’s light footprint strategy).

Syria is expected, as during the Obama administration over 11 percent of their population were killed and the refugee problem was the biggest threat to the EU project of the past 20 years. But I think his association with Syria will be the tragedy of what happened there and not the “red line” as argued by Daniel. I think the future way we frame Syria will be that Obama was callous and allowed it to happen which is not fair to him but that isn’t the point of Daniel’s list.

Oddly left off the list is the return to geopolitics in Ukraine and the South China Sea, ISIL, the failure of TPP, and what I consider his biggest foreign policy blunder, Libya.

In Libya, it was one policy mistake after another. If 9/11 meant domestic institutions replaced power distributions as America’s biggest security concern, why create a failed state? Why overturn a regime which actually cooperated with the United States on its various weapons program, complicating our credibility with nuclear powers or aspiring nuclear powers. It seems obvious to me that Libya damaged our credibility more than the “red line” ever did. Lastly, if the list is to correctly identify what failures will color the legacy of the Obama administration once he leaves office, Benghazi will also play a role in cementing “all things Libya” as his biggest policy debacle aboard.