When Sen. Sanders began his presidential campaign, he included single payer in his program and reporters began to contact me because my report is the only economic study of the financing and impact of a single payer plan. The WSJ in particular used some numbers from my study, out of context I might add, in their attack on Senator Sanders. Hillary also attacked the Sanders single payer plan on really illegitimate grounds.

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My guest today is Gerald Friedman, professor of economics at University of Massachusetts, Amherst. Welcome to OpEdNews, Jerry.

JB: You've inadvertently found yourself in the spotlight of late. How did this come about?

JF: I've always had an interest in health policy because I have believed that everyone should have a right to healthcare as part of our inalienable right to "life, liberty, and the pursuit of happiness". In 1978, I went to Washington as part of a group, "Democratic Action," organized by the late Michael Harrington to lobby for Senator Ted Kennedy's single-payer bill. Through the next 30 years, I wrote a few short pieces about health policy and that attracted some attention so that a group promoting a single-payer plan for Massachusetts asked me to draft a report on the economic consequences of a single-payer program there.

That report attracted more attention and I was asked to write reports for other states: Maryland and then Pennsylvania and Colorado. And in 2013, Physicians for a National Health Plan asked me to write a report for the financing and economic impact of a national single payer plan, HR 676. When Senator Sanders began his presidential campaign, he included single payer in his program and reporters began to contact me because my report is the only economic study of the financing and impact of a single payer plan. The Wall Street Journal in particular used some numbers from my study, out of context I might add, in their attack on Senator Sanders. Since the WSJ article, a steady flow of reporters and others have contacted me to discuss economics of single payer.

I am delighted that single payer is getting this attention and I am able to contribute to the campaign to bring better and less-expensive health care to the American people. But this is a bit of a mixed blessing! I have other responsibilities (to students and the University), and other research interests. And, I have a dog to walk.

JB: Let's not forget that dog! So, your visibility is both good and bad: good in that single payer is getting well-deserved attention but the numbers in your study have been taken out of context. How did the WSJ mishandle them, Jerry?

JF: The WSJ reported the cost without the benefits. They acted like economists in a bad joke: "Economists know the price of everything but the value of nothing!" So they gave an estimate of how much people would be spending on a single payer plan without acknowledging how much individuals and businesses would save by not having to pay for private health insurance and for copays and deductibles. Furthermore, savings will increase over time because every country that has a national healthcare system has lower inflation rates in health care than the US!

Single payer systems save money because they (1) have lower administrative costs because it is more efficient to process bills in one pipeline -- Medicare has overhead of less than 2% while private health insurance companies have overhead rates of over 12%. This would save us $200 billion in the first year of a single payer program. (2) they have lower administrative for providers because they send the bills to only one company. Many American hospitals have more people doing Billing and Insurance Related (BIR) activities than they have beds or doctors! American physicians spend hours every week and over $90,000 per physician on these activities. Most of the BIR costs in provider offices disappear in a single payer program. This saves another $200 billion. (3) Drug prices are nearly twice as high in the US as in other countries because pharmaceutical companies can exploit their monopolistic power against fragmented insurance companies and individuals. In the US, only the VA is able to bargain with drug companies effectively and they pay prices barely half what the rest of us pay! A single payer program could save over $100 billion through negotiated drug prices, just like they do in Canada, France, Italy . . .

(I could tell you a story about when we were in Florence, Italy, and our younger daughter got sick!*)

Altogether, a single payer plan would save Americans $600 billion in the first year, with savings rising over time because the plan would control the growth in monopolistic pricing and administrative expense. This is what has happened for Medicare in the US, for Medicare in Canada (what they call their single payer system -- they call it that to make fun of us!) For 45 years (since 1971) health care prices in the two Medicares have risen at 1.1% a year less than in the private health care system in the US. Had the rest of the US health care system controlled prices that effectively, we would be saving $1.5 trillion this year!

Had the WSJ talked about the savings, they would have written a very different story: spend a little more in public taxes and save a lot in the "private taxes" that we are required to pay to private health insurers (because we are required to buy health insurance!).

JB: I'm very interested in the Florence story, Jerry. Maybe you can save that for later on in our conversation. Do you have any speculations on why the WSJ gave just half of the story? But, more importantly, the Journal's distortion of your work has been picked up elsewhere and made its way into the current presidential primary free for all. What can you tell us about that?

GF: While the reporter for the WSJ was very conscientious, I imagine the editors wanted to make a political statement by putting out an alarmist view that Bernie Sanders, and the Left, were going to take everyone's money. I am disappointed but don't expect much better from the Wall Street Journal. I am disappointed that the Clinton campaign is spreading some of the same misinformation!

I think that this is bad politics for Hillary: the public is ready for positive public programs to address our needs for education, infrastructure, social insurance and health care. It is also bad public policy for her because rather than catering to it, she should be countering the anti-government and anti-public service rhetoric from the WSJ and other right-wing sources. I think that her campaign has been panicked by the strength of the Bernie Sanders campaign.

There is a great deal of popular unrest out there. On the GOP side, it is flowing to Trump; on the Democratic side, it is going to Sanders. Both campaigns are drawing on the widespread discontent with the weak economic recovery and with 40 years of stagnant wages and declining living standards for American workers. Trump is giving a negative message: blaming immigrants, blacks, women. Sanders has a positive message: public policies to raise wages and rebuild the middle class. Hillary should get with the positive message rather than undermining it!

JB: What did Hillary do or say? Was it her or her campaign, ostensibly speaking in her name? Obviously, there's a difference. Many of our readers, including myself, may not be aware of exactly what happened.

GF: Campaigning for her mother, Chelsea Clinton said a few days ago: "Sen. Sanders wants to dismantle Obamacare, dismantle the [Children's Health Insurance Program], dismantle Medicare, and dismantle private insurance. I worry if we give Republicans Democratic permission to do that, we'll go back to an era -- before we had the Affordable Care Act -- that would strip millions and millions and millions of people off their health insurance."

Huffington Post: Chelsea Clinton Said Bernie Sanders Would Take Health Care from Millions

This statement is misleading bordering on irresponsible. Of course, single payer, Improved Medicare for All, dismantles these programs because it replaces private insurance with a better and cheaper national insurance. It is ridiculous to say that people would be stripped of their health insurance; under single payer, everyone would be covered.

That is why I wrote a little note to Chelsea.

JB: That's Chelsea, though, Jerry. How about Hillary herself? Did she also misrepresent you?

GF: Hillary also attacked the Sanders single payer plan on really illegitimate grounds*. According to FactCheck.org:

The day before, on Jan. 11, Hillary Clinton said at a campaign stop in Iowa, that Sanders' plan would "take Medicare and Medicaid and the Children's Health Insurance Program and the Affordable Care Act health-care insurance and private employer health insurance and he would take that all together and send health insurance to the states, turning over your and my health insurance to governors." Sanders has proposed having the states implement the single-payer plan, but there would be tight federal oversight and their role would be like that of private insurers who process claims for Medicare. Clinton implies that governors would be free to do whatever they wanted. That's not the case.

In the last presidential debate (January 17), Hillary took a much more responsible posture and criticized Sanders, and single-payer advocates, for campaigning to revolutionize health care, something that will not happen, rather than working to achieve possible reforms by improving existing programs. This is a reasonable position for which I have sympathy. The Affordable Care Act (Obamacare) is saving thousands of lives by extending insurance coverage; it is a great accomplishment. I think that it is also just about the end of the road for reforming the private insurance system. The ACA extends and improves insurance coverage by buying support from the insurance, hospital, and drug industries. They acquiesce in the law's reforms because it does nothing to lower costs or to challenge their inflated incomes. But that means we have health care costs rising at unsustainable rates and no way of bringing them down. To control costs, we have to attack someone's income, precisely the problem facing single payer politics.

Anyway, I helped the Sanders campaign on their numbers. To be sure, if Hillary asked me, I would help her too. Like Hillary and Senator Sanders, I am involved because I want to contribute to making this a better country, not to elect anyone in particular.

JB: Thanks so much for clarifying that. Anything you'd like to add before we wrap this up?

GF: Just one more thing about the purpose of our healthcare system For most people, it is obvious: to provide health care and promote better health! But that isn't the goal of our health insurers, pharmaceutical manufacturers, and even many hospitals. For these capitalist businesses, their goal is to make profits and if they can do it by providing health services, great; otherwise they will do it by raising prices and by restricting access to services in ways that undermine health. Consider the term "medical loss ratio." This is the share of insurance premiums that go to health care services. If we want to provide health care, we want this ratio to be high, as it is in traditional Medicare where it stands at about 98%. For most private insurance companies, however, it is well below 90%; on average, health insurers have a medical loss ratio of 87-88% meaning that 12-13% of our premiums go to other activities, such as marketing, administration, CEO pay, and profit. Private for-profit companies want a low medical loss ratio, and when the ratio goes up, their stock price falls! Their attitude, even the use of the term "medical loss" rather than "care delivery", is the exact opposite of how we see things. That is why we need to get the profit motive out of healthcare, and replace for-profit insurance with a national Medicare-for-All system.

JB: I'm with you, Jerry! Thanks so much for talking with me. I'm glad we were able to clear up the muddle regarding your work and the Clinton campaign.

*bonus story about Italy:

GF: I was in Rome on sabbatical (writing a book on American liberalism, still working on it) in Fall 2013. Our younger daughter, recent college graduate at the time, was traveling around Europe and came to visit and we took her up to Florence. On the way there, she started feeling sick and after visiting the Uffizi (priorities) we took her to the ER at Santa Maria Nuova, one of the oldest hospitals in Europe. The doctor found she had an ear infection and gave her two prescriptions (pain relief and antibiotic). Leaving, my wife asked him how to pay and he looked quizzically at her and said they were all done, "Ciao". She took out her credit card and asking where she should go to pay while waving it at a nurse who responded: "Italian hospital, no pay. Not like America."

My wife took our daughter to our apartment but, as the dad, I was charged with getting the prescriptions filled. I took them to an open pharmacy across from the Duomo. The view was stunning but I was disappointed to see there were no magazines to look at while I waited. The reason was soon obvious: without having to deal with insurance, the pharmacist fills prescriptions very quickly. And, they were cheap! 13 Euros (about $16) for the two. When I returned home, I asked at CVS how much they would have been: $57. The Italian government buys for all of Italy and negotiates drug prices.

Thanks very much for your interview! It was fun!! And I've heard positive feedback and noticed many retweets and facebook postings!

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*According to the Institute for Public Accuracy: "Clinton is apparently echoing a Wall Street Journal piece from last year: "Price Tag of Bernie Sanders' Proposals: $18 Trillion," which relies on the analysis of Professor Gerald Friedman."

Authors Website: http://www.opednews.com/author/author79.html

Authors Bio:

Joan Brunwasser is a co-founder of Citizens for Election Reform (CER) which since 2005 existed for the sole purpose of raising the public awareness of the critical need for election reform. Our goal: to restore fair, accurate, transparent, secure elections where votes are cast in private and counted in public. Because the problems with electronic (computerized) voting systems include a lack of transparency and the ability to accurately check and authenticate the vote cast, these systems can alter election results and therefore are simply antithetical to democratic principles and functioning.



Since the pivotal 2004 Presidential election, Joan has come to see the connection between a broken election system, a dysfunctional, corporate media and a total lack of campaign finance reform. This has led her to enlarge the parameters of her writing to include interviews with whistle-blowers and articulate others who give a view quite different from that presented by the mainstream media. She also turns the spotlight on activists and ordinary folks who are striving to make a difference, to clean up and improve their corner of the world. By focusing on these intrepid individuals, she gives hope and inspiration to those who might otherwise be turned off and alienated. She also interviews people in the arts in all their variations - authors, journalists, filmmakers, actors, playwrights, and artists. Why? The bottom line: without art and inspiration, we lose one of the best parts of ourselves. And we're all in this together. If Joan can keep even one of her fellow citizens going another day, she considers her job well done.


When Joan hit one million page views, OEN Managing Editor, Meryl Ann Butler interviewed her, turning interviewer briefly into interviewee. Read the interview here.

While the news is often quite depressing, Joan nevertheless strives to maintain her mantra: "Grab life now in an exuberant embrace!"


Joan has been Election Integrity Editor for OpEdNews since December, 2005. Her articles also appear at Huffington Post, RepublicMedia.TV and Scoop.co.nz.