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WASHINGTON (AP) —
Democratic presidential candidate Bernie Sanders calls his plan for a government-run health care system "Medicare for all." But it's not.
With full coverage for long-term care, most dental work included, no deductibles and zero copays, the Sanders plan is far more generous. Think of it as Medicare on growth hormones.
Ideology aside, the sweeping scope of Sanders' plan and a lack of detail have raised questions. Some health care experts see it mainly as a political document to distinguish Sanders' revolutionary ideas from Hillary Clinton's incremental approach.
Sanders runs the risk of looking "like he is living in a fantasy land, for putting forward an idea he can't possibly deliver during his term in office," said Drew Altman, president of the nonpartisan Kaiser Family Foundation.
Last Sunday, the Vermont senator released an 8-page outline of his plan for cradle-to-grave government-sponsored coverage for all. The campaign estimates it would cost $1.38 trillion a year, paid for with new taxes that would take the place of private health insurance premiums. Here's a look at some things Sanders left out:
NOT LIKE MEDICARE
Medicare doesn't cover long-term care, not to mention dentures, and seniors face deductibles and cost-sharing when they go to the doctor. Many buy an additional private insurance policy to cover Medicare gaps. "BernieCare," as it is being called, would be above and beyond.
"It's not Medicare for all," said Republican economist Gail Wilensky, who ran Medicare under former President George H.W. Bush. "It's nonsense to talk about it as if it were. You're just giving people a comfort level that's inappropriate."
Sanders' plan is also different because the government would have to take an assertive role managing access to new technologies and drugs in order to control costs, Wilensky said.
Even if there are important differences with Medicare, supporters of Sanders' plan say it's similar in the sense that virtually all seniors are covered under that program. Sanders' approach is also called 'single-payer,' because the government would become the steward of the health care system, currently about one-sixth of the economy.
PATH TO SAVINGS UNCLEAR
Sanders says his plan will cost $6 trillion less over 10 years than the current health care system. But his path to savings is unclear.
For starters, a government takeover of health care financing would eliminate all the useful signals about value that private payers generate. A few years ago, it became obvious Medicare had a problem paying for home medical equipment when government officials could find the same items on the Internet for much less.
"How do you learn about the value of things if you don't have an accompanying private sector?" asked economist Paul Hughes-Cromwick of the Altarum Institute, a Michigan-based nonprofit that does research and consulting. "All of a sudden you wouldn't have an empirical basis on which to build."
Altman, the Kaiser foundation president, said it's possible a single-payer system could produce substantial savings, for example by eliminating administrative duplication among insurers.
"I can't say how big those savings would be from the Sanders plan because all we have is a sketchy outline," he added. Any significant savings would have to come from reductions in payments to hospitals and doctors, not discussed in the campaign outline.
TEST A LITTLE, BUILD A LITTLE?
Back in 2013, the Obama administration famously promised that the president's health care plan would launch on the same day in all 50 states. But when they flipped the switch, the HealthCare.gov website didn't work. Sanders' plan makes no mention of a phase-in, meaning the government would have to get everything right the first time.
The head of one of the country's largest hospital groups said a test of some kind would seem prudent.
"If the nation wanted to experiment, we would be willing to look at the details and consider being supportive — but the details are huge," said Sister Carol Keehan, CEO of the Catholic Health Association.
As nonprofits, Catholic hospitals are not locked into any particular payment model, Keehan explained. The U.S. could do better. "There is no question a lot of money in the delivery system is poorly spent," she said.
Sanders' own state had wanted to implement a single-payer system. But Vermont recently pulled back after the magnitude of expected tax increases became clear.
"Bernie may have a bigger job on his hands than he understands, trying to get people to just take a look at this," Keehan said.
LESSONS FROM TAIWAN
Most economically advanced countries with government-run health care set up their systems long ago, but Taiwan's National Health Insurance is newer, celebrating its 20th anniversary last year.
Princeton University researcher Tsung-Mei Cheng said there are lessons from Taiwan for any country contemplating the move.
Taiwan's system has been very popular with the public, but the government had to expand the tax base to keep pace with costs. The system does have copays, although they are affordable for most middle-class households. Doctors' use of costly technologies such as MRIs is closely monitored. And it can take three to five years after expensive new drugs are introduced elsewhere for them to become widely available in Taiwan.
For single-payer to gain acceptance here, Cheng said Americans would have to change their mindset.
"You would have to have a social consensus that health care is a right, and not only everyone should have it, but everyone should have the same," said Cheng.
LOS ANGELES (AP) —
With tens of thousands of Central American immigrants arriving on the U.S.-Mexico border in the last two years, federal authorities are launching a program Thursday to encourage more of them to show up for their hearings in immigration court.
Immigration and Customs Enforcement hired a contractor to help some immigrant families find transportation, housing and low-cost lawyers, hoping that getting them on stable footing will make them more likely to attend court hearings that determine whether they should be allowed to stay in the country or deported.
When immigrants show up for court, federal authorities can keep track of asylum cases to ensure those who lose return home. Advocates want immigrants to attend the hearings because they believe many of those arriving from El Salvador, Guatemala and Honduras have a strong shot of winning asylum but must be in court to do so. Judges routinely issue deportation orders for those who don't show.
As many as 800 families who pass an initial asylum screening can join the program in Los Angeles, New York, Washington, Chicago and Miami starting Thursday. Caseworkers will help newly arriving immigrants with tasks such as finding transportation to immigration court and enrolling their children in school. Later, they will help those who lose their bids to stay in the country head home.
The program will cost $11 million a year and reach a tiny sliver of the 54,000 Central American immigrants with children who have arrived on the southwestern border since October 2014. It comes as the Obama administration faces court-imposed limits on the detention of immigrant families and as authorities began arresting those who lost their asylum cases in raids earlier this month.
Those eligible for the program include pregnant women, nursing mothers and immigrants with mental illness, ICE said.
"We are looking at Central American mothers, predominantly heads of households, because that is what we're seeing now as the biggest population to be served," said Andrew Lorenzen-Strait, a deputy assistant director for enforcement and removal at ICE.
Since 2014, immigrant families have been sent to family detention centers or released and told to appear in immigration court.
Nearly 790 deportation orders have been issued for immigrants with children who have arrived since July 2014 and were detained. More than two-thirds were for those who didn't show up for hearings, court statistics show.
Advocates welcomed the new program, hoping immigrants can prove they are fleeing persecution and win the right to stay in the U.S. It faces opposition from those who want the government to quickly screen immigrants on the border and turn away those who don't qualify for asylum.
"Instead, the administration continues to take actions that encourage more illegal immigration, such as providing taxpayer benefits to those who have come here illegally," said Rep. Bob Goodlatte, the Republican chairman of the House Judiciary Committee.
Immigrant advocates said newcomers are often overwhelmed when they start life here and may miss key hearings if they get bogged down with enrolling their children in school or forget to update their address with the courts.
They applauded the aid to immigrants but questioned ICE's selection of a contractor to run the program that is a unit of GEO Group, which also oversees immigration detention centers. The company declined to comment.
The surge in border arrivals has stoked raucous debate on the presidential campaign trail and in Washington. The Obama administration arrested 121 people with deportation orders several weeks ago in raids targeting Central Americans who came here in recent years.
Since last year, federal authorities have released immigrant families more quickly from detention centers after a federal judge ruled that mothers with children could not be held for lengthy periods of time. Some were outfitted with ankle bracelets after being freed.
Before launching the new plan, ICE ran a pilot program with two nonprofits in which participants almost always attended their immigration hearings and appointments, agency officials said.
"A lot of these people are not going to be deported," said Annie Wilson, chief strategy officer for Lutheran Immigration and Refugee Service. "The more important question is: How should we be treating people who are going to be here, and who are going to win asylum?"
DES MOINES, Iowa (AP) —
Carly Fiorina has a husband who quit his career to further hers. Chris Christie boasts of his wife being the family's top earner. Hillary Clinton is looking to get back into the White House, but this time as president.
In the 2016 presidential campaign, a modern take on gender roles is increasingly on display in both parties.
With two women running for president, a number of high-powered career spouses in the mix and an increased focus on policies to support two-income families, 2016 is shaping up as a different kind of election, said Anne Marie Slaughter, who four years ago wrote a popular essay in The Atlantic on why she left a job in the State Department to spend more time with her family.
"I think what is changing is, this is the year of the family," said Slaughter, now president and CEO of New America, a Washington-based nonprofit. And that means more attention on "how you support the family with policies for women and men."
While more women have been running at a state and local level, this is the first time both parties have a woman running in a serious way. This gives former Michigan Gov. Jennifer Granholm reason to hope decisions about running for office are no longer just being made "based on one's plumbing."
Compared with her 2008 run, heavy on national security, Clinton this time has heavily stressed issues that are meant to appeal to women and families: health care, pay equality, education, child care, family leave. She says "these aren't just women's issues, they are economic issues that drive growth and affect all Americans."
This is murky territory for Clinton. She has a long record as an advocate of women's advancement and speaks often and passionately about her baby granddaughter. But her potential Republican rivals have raised questions not only about her husband's past infidelities but about how she might have contributed to efforts to discredit some of the women known or alleged to have been involved with him. Donald Trump flatly accused her of enabling Bill Clinton's philandering.
Among Republicans, Florida Sen. Marco Rubio has proposed increasing the child tax credit and creating a tax credit for employers that provide family leave. Rep. Paul Ryan asserted his need for family time when agreeing to become House speaker.
Christie says voters are meeting a new generation of candidates with "different types of marriages and different types of relationships than people in the generation before. It really is necessitated by the increasing role and prominence of women in the workforce and by necessity, too."
Dianne Bystrom, director of the Carrie Chapman Catt Center for Women and Politics at Iowa State University, said that in recent years there has been a shift in both how female candidates talk about their personal lives and family-oriented policies.
The political reasons are clear.
"The Democrats have to mobilize the base and the Republicans have to whittle away at the women's vote," said Debbie Walsh, director of the Center for American Women and Politics at Rutgers University.
Support from women, who typically lean toward Democrats, was vital for President Barack Obama, who won re-election in 2012 with 55 percent of female voters, while Republican opponent Mitt Romney won 52 percent of men, according to exit polls analyzed by Walsh's center. Obama won about the same percentage of women in 2008 as he did in 2012.
The two-career marriages on display in the campaign are in keeping with the rise of women in the workforce. About 58 percent of working-age women were employed in 2012, compared with 38 percent in 1963, federal statistics show. Mothers work at even higher rates — with about 70 percent of women with children under 18 working.
Christie's wife, Mary Pat Christie, was a former Wall Street executive who out-earned him for most of their marriage. Heidi Cruz, wife of Texas Sen. Ted Cruz, is on leave from her job at Goldman Sachs. Jane Sanders is a key adviser to husband Bernie Sanders. And Fiorina's husband, Frank, was a corporate executive until he retired early to support her high-powered career.
With a more diverse group campaigning, the role of political spouse may get a reboot.
Ex-President Bill Clinton and Frank Fiorina are campaigning in Iowa as potential "first gentlemen." Many of the other spouses are out on the trail.
The campaign has also gone beyond the usual (and still ubiquitous) sugar-coating of family life of the candidates, as Fiorina discussed the stepdaughter she lost to drug and alcohol addiction, Jeb Bush opened up about the daughter who's struggled with drug abuse and Christie acknowledged a complicated marital history.
Still, stereotypes tend to die hard. During a recent Republican debate, Christie seemed caught in a time warp back to the 1950s when talking about Los Angeles families dealing with a terrorist scare.
"Think about the mothers who will take those children tomorrow morning to the bus stop wondering whether their children will arrive back on that bus safe and sound," he said. "Think about the fathers of Los Angeles, who tomorrow will head off to work and wonder about the safety of their wives and their children."
And then there's Trump, who has tossed various sexist insults at certain women — saying at one point that a debate moderator had "blood coming out of her wherever" — yet insists at rallies that he would "cherish women" as president.