19 min read
It's fair to say that American politics is having a meltdown.
The poster child is Donald Trump, the heir to a multi-million dollar empire who would have made more money if he'd spent his life finger-painting, but nonetheless portrays himself as a shrewd deal-maker. In one sense, he is a businessman: he's found a gap in the voting market - a poorly-educated, disenfranchised group of voters hungry for scapegoats - and is milking it for all it's worth. Anyone with barely a passing knowledge of 20th century history should be terrified of the rhetoric he's cynically used to build himself a following, and the repercussions of his campaign will be felt for a generation.
A lot of people see Bernie Sanders as being on the same spectrum: an appeal to disenfranchised voters who need something new and don't know any better. I disagree: I think there are very rational reasons to support Bernie over other candidates. (This does not mean that I wouldn't support a Hillary Clinton nomination. I would absolutely vote for her if she was the Democratic candidate.)
There's been a lot of shouting from supporters on both sides, from Trump fans to Bernie Bros. I don't think it's productive or interesting. So let's just say this up-front: I don't need you to agree with me, but I would genuinely love to hear what you think. I think sharing arguments - not shouty arguments, but the logical kind - makes us all smarter. Freedom of speech is a gift.
Where I come from
I think this is worth saying, as it undoubtedly colors my opinion: I'm an American citizen, but I grew up in England. That means I grew up using the socialized National Health Service. I was also in the last ever university class to not have to pay any tuition fees: I attended the University of Edinburgh tuition-free, and so did every single one of my domestic classmates. (Foreign students had to pay.) So I grew up with a lot of Bernie Sanders campaign promises; they were my reality.
I attended state schools for my entire childhood. Some of these were co-run by the Church of England, but I was taught that evolution is a fact, that homosexuality is not a sin, and so on. Evangelical religion and religious restrictions on education were not a part of my reality. (For what it's worth, I'm a lifelong atheist, despite this educational background.)
Terrorism was a part of life: the IRA conducted a bombing campaign for most of my childhood.
Who am I now? I'm the founder of Known, a startup based in San Francisco. As a startup founder, I am not anti-capitalism. I want to make money solving problems for people (in an ethical way).
One of the core promises in the Sanders manifesto is free healthcare for all:
Bernie’s plan would create a federally administered single-payer health care program. Universal single-payer health care means comprehensive coverage for all Americans. Bernie’s plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary care to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.
It sounds great, but understandably, there have been a lot of worries about how this will be paid for. There is a justifiable argument that this will increase government spending; meanwhile, the Sanders campaign argues that it will save $6 trillion over the next ten years when you consider government subsidies of the existing system.
The economic arguments against universal healthcare seem to assume that growth in medical costs will not increase, but fail to take into account the drop in medical costs once you remove the insurance-based system. Today, a simple blood test can easily cost over a thousand dollars; removing the existing closed marketplace system will reduce these. As Vox noted:
Sanders's plan is very optimistic, assuming huge reductions in per-person health care spending that bring the US much closer to existing countries with single-payer like Canada (which spends nearly 48 percent less per person) or Australia (more than 56 percent less). "If you look at every other country that has adopted a universal single-payer health care system, their costs per capita are far lower than they are in the United States," Gunnels told me.
If the government manages to reduce these costs, the Sanders plan makes economic sense. If you don't believe that the costs of procedures and materials will shrink under a single-payer system, there are more questions.
However, containing costs is vital for the future of American healthcare. As Dr Ed Weisbart noted in the American Medical Association's Journal of Ethics back in 2012:
A single-payer model would eliminate the inefficiencies of fragmentation by converting public programs such as Medicare, Medicaid, and CHIP into a single administratively efficient financing system. Streamlined billing under single payer would save physicians vast amounts in overhead. In addition to reduced billing expenses, physicians would also enjoy a meaningful drop in their malpractice premiums.
[...] We spend more but use less of most services than other member nations of the Organization for Economic Cooperation and Development. In other words, our prices are much higher. [...] Only a single-payer system enables the kind of bulk purchasing of drugs and medical devices that would give the buyer power. A model for this structure exists today in the United States: the Department of Veterans Affairs. Due to governmental authority to negotiate drug prices for the VA, it pays roughly half of the retail price of drugs.
There is precedent, in other words, for government healthcare programs to reduce healthcare costs.
Access to healthcare isn’t just an important social issue: I believe large out-of-pocket medical costs have a chilling effect on innovation.
I pay for my own healthcare insurance, which comes to around $290 a month. This plan comes with a $6,000 deductible, which means I pay the first six grand of any costs I have. In other words, while this will prevent me from going bankrupt if I'm hit by a bus or get cancer, it won't save me anything when it comes to regular doctor's appointments over the year.
$290 isn't a completely unreasonable amount if I'm making an above-average middle class salary. As a startup founder, however, I don't. I know health insurance is important (and that I'm legally required to have it) so I pay for it every month, but as a chunk of my monthly outgoings, it's second only to my rent.
For many would-be entrepreneurs, these out-of-pocket costs have a real effect on their ability to take risks and start a business. Most people get health coversage through their employer - something that goes away when you start your own business. As the Philadelphia Inquirer reported in 2009, this is a problem:
"We think it's a major impediment to growth," said Robert E. Litan, vice president for research and policy at the Ewing Marion Kauffman Foundation, which promotes entrepreneurship. "There's so much logic that supports it, it's almost impossible to deny.
Decoupling healthcare from employment would remove barriers for a class of people to start businesses. It would certainly have made a real difference in my life as an entrepreneur. In addition to the social reasons for having a healthy, working populace, this is why I support the Sanders universal healthcare plan.
The Sanders manifesto promises to work towards eliminating tuition fees at public colleges and universities, reducing student loan interest rates, and providing better grant support for low-income students:
In a highly competitive global economy, we need the best-educated workforce in the world. It is insane and counter-productive to the best interests of our country and our future, that hundreds of thousands of bright young people cannot afford to go to college, and that millions of others leave school with a mountain of debt that burdens them for decades. That shortsighted path to the future must end.
Two reasonable questions might be: what kind of impact will free college tuition really have, and how will we pay for it?
As Bob Samuels, President of the University Council - American Federation of Teachers, wrote in 2011:
Currently, only 30% of Americans who start college or university end up graduating, and this represents a huge waste of time and money. If students did not have to work while in school, the graduation rate would improve drastically, and students at universities could graduate in four years instead of six or more years. In fact, the biggest reason why students drop out of higher education is that they cannot afford the high cost of tuition.
We've known for a while that college graduates earn more - about $1 million more - over their lifetimes. It turns out they benefit their local communities, too. In 2015, the Brookings Institution released a study noting that college graduates yield an enormous benefit for their local economies:
Using data from the 2013 American Community Survey (ACS), Rothwell calculated that the average college graduate spends $278,000 more on local goods and services—in addition to $44,000 more on state and local taxes—than the average high school graduate. Even someone with an associate’s degree spends around $81,000 more.
This effect strongly depends on an area's ability to keep graduates once they enter the workforce, and some cities are better at this than others. Nonetheless, ensuring that more people graduate from college will have secondary and tertiary benefits in communities across the United States - and if low-income students get better support, those benefits will be seen in more disadvantaged communities, too.
Peter R. Orszag, vice chairman of corporate and investment banking and chairman of the financial strategy and solutions group at Citigroup, agrees on the positive economic effect of more college graduates:
More graduates would mean lower inequality, because the wage premium for a college degree would be reduced by the additional supply. And it would mean higher national income, because better-educated workers are, on average, more productive.
While researching this post, I wondered whether the employment market could actually absorb more graduates. The data on this turns out to be contentious, but the Georgetown Center on Education and the Workforce suggests it can:
[Our predictions] suggest that the economy will create 55 million new job openings over the next decade, and 65 percent, or 37 million, of these new job vacancies will require some postsecondary education and training.
Great. So how are we paying for this again?
Sanders wants to impose a tax of "a fraction of a percent" on "Wall Street speculation" in order to raise the $75 billion a year needed to pay for it. This translates to "50 cents on every $100 of stock trades on stock sales, and lesser amounts on transactions involving bonds, derivatives, and other financial instruments".
Would this minor restriction on trading really raise enough money? Absolutely (PDF link):
It is argued that trading volume will be sharply reduced in response to the tax; therefore the government will collect little revenue. In fact, the calculations of the revenue raised through a tax assume sharp reductions in trading volume. Current levels of trading are so large that even a 50 percent reduction in volume would still lead to a very substantial amount of revenue being collected. A calculation based on 2008 trading volumes showed a broadly based tax collecting more than $170 billion a year, assuming that trading volume falls by 50 percent.
In 2010, the Institute of Development Studies in Britain investigated this form of taxation and concluded that the UK should implement it, ideally in conjunction with other governments worldwide. Other supporters include David Stockman, who was the Budget Director for Ronald Reagan's government, Warren Buffett, and Lawrence Summers. (Oh, and the potential reduction in trading volume? That would bring us down to 1980s levels.)
The policy, then, benefits lower-income students, creates prosperity in communities all across America, and pays for it by imposing a minor tax that most taxpayers will never see.
There's been a lot of talk about Sanders being a single-issue candidate. Nowhere has this been more pointed than his perceived lack of foreign policy expertise:
Sanders has yet to give a speech exclusively on foreign policy, and on Friday his campaign backed away from an earlier commitment to deliver one before the Iowa vote. Numerous Democratic foreign policy insiders contacted by POLITICO could not name anyone who regularly advises the Vermont Senator on world affairs — a stark contrast to a Clinton campaign teeming with several hundred foreign policy advisers. It is also a contrast to Barack Obama's 2008 campaign, which by this point in that campaign featured a cadre of prominent foreign policy hands, including former national security advisers Anthony Lake and Zbigniew Brzezinski.
Foreign policy is vital. America's actions overseas affect its actions domestically, and vice versa; it isn't possible to cleanly separate one from the other. As such, this decision by the Sanders campaign is questionable.
Understanding a candidate's stance on American policy is important to me. We have by far the largest military in the world (spending four times as much as China, which comes in at number two), and almost 20% of the federal budget is spent maintaining it. We enact and enforce ubiquitous surveillance worldwide and domestically, despite zero evidence that it helps keep anyone safer. Hawkish US foreign policy helped create ISIS - and before it, Osama bin Laden and al-Qaeda. It used torture. And all of this is just in the 21st Century. America's post-World War Two history of warfare and foreign operations is shameful, from the horrors of the war in Vietnam, through the assassination of Salvador Allende, to the Iran-Contra affair. Beyond warfare, the US has furthered a conservative agenda overseas, including tethering US assistance fighting AIDS to abstinence-based programs.
No wonder most of the world sees the United States as a negative, destabilizing force.
In turn, the perception that the United States is a combative, rather than collaborative, force makes us less safe. As Newsweek reported:
The most likely—though not most lethal—terror threats to Americans come from individuals living within the United States who are partially motivated to undertake self-directed attacks based upon their perception that the United States and the West are at war with the Muslim world.
In this global landscape, it's unforgivable to gloss over foreign policy.
Luckily, Sanders actually does have extensive experience. Lawrence Korb, senior adviser to the Center for Defense Information and a senior fellow at the Center for American Progress, wrote recently:
In my dealings with him, and in analyzing his record in Congress over the past 25 years, I have found that Sanders has taken balanced, realistic positions on many of the most critical foreign policy issues facing the country. In the mold of realists like Brent Scowcroft, national security adviser to Presidents Richard Nixon and George H.W. Bush, Sanders voted against the invasion of Iraq in 2002, while wisely supporting the war against in Afghanistan in 2001 and the intervention in the Balkans in 1990s. And Sanders certainly isn’t a foreign policy lightweight: In fact, given his long tenure in the House and Senate, he has more foreign policy experience than Ronald Reagan or Barack Obama did when they were running for office the first time.
Korb goes on to detail how Bernie Sanders repeatedly votes for a restrained, but realistic, military strategy (for example, while he was against the invasion of Iraq, he supported action in Afghanistan). He has an "admirable commitment to diplomacy".
Sanders has put climate change front and center as the greatest threat to national security, and I believe this is correct. For example, a peer-reviewed study last year showed that drought was a major contributing factor to the conflict in Syria:
There is evidence that the 2007−2010 drought contributed to the conflict in Syria. It was the worst drought in the instrumental record, causing widespread crop failure and a mass migration of farming families to urban centers. Century-long observed trends in precipitation, temperature, and sea-level pressure, supported by climate model results, strongly suggest that anthropogenic forcing has increased the probability of severe and persistent droughts in this region, and made the occurrence of a 3-year drought as severe as that of 2007−2010 2 to 3 times more likely than by natural variability alone. We conclude that human influences on the climate system are implicated in the current Syrian conflict.
Sanders has also argued against ubiquitous surveillance, which has been a significant infringement of our domestic rights and has had a chilling effect on journalism and freedom of speech.
A more peaceful, diplomacy-led foreign policy that also protects our rights at home will make us safer and allow the United States to be proud of its role in the world. I support this approach.
This is the elephant in the room, and it's where I part from Bernie Sanders. His positions on gun control and the causes of mass shootings have been outright wrong. (Gregory Meeks called Sanders' record "troubling" recently, but I don't think that word is strong enough. "Troubling" is what you call an off-color joke; guns are responsible for thousands of deaths every year.)
In an interview with NPR last year, Sanders said he didn't think gun control would solve America's violence problem:
"So obviously, we need strong sensible gun control, and I will support it," Sanders told Greene. "But some people think it's going to solve all of our problems, and it's not. You know what, we have a crisis in the capability of addressing mental health illness in this country. When people are hurting and are prepared to do something terrible, we need to do something immediately. We don't have that and we should have that."
It's true that America needs better healthcare, including mental healthcare, and this is addressed in his policies. However, I think it's disingenuous, counterproductive and deeply harmful to blame gun violence on mental health issues. The New York Times Editorial Board called this out last year:
But mass shootings represent a small percentage of all gun violence, and mental illness is not a factor in most violent acts. According to one epidemiological estimate, entirely eliminating the effects of mental illness would reduce all violence by only 4 percent. Over all, less than 5 percent of gun homicides between 2001 and 2010 were committed by people with diagnoses of mental illness, according to a public health study published this year.
Indeed, the single biggest predictor of gun violence is gun ownership. Or to put it another way, to curtail gun violence, we need fewer guns. States with stronger gun laws have fewer gun deaths.
For a candidate who puts such an emphasis on social justice issues, Sanders' stance here seems incongruous. He's at once ignoring an issue that disproportionately affects low-income African Americans, while also stigmatizing mental illness.
There's an argument that Vermont's status as a rural state makes it harder for him to support gun control, which he made on Meet the Press last year:
I come from a state that has virtually no gun control. And yet, at political peril, I voted for an instant background check, which I want to see strengthened and expanded. I voted to ban certain types of assault weapons, which are designed only to kill people. I voted to end the so-called gun show loophole. What I think there needs to be is a dialogue. And here's what I do believe: I believe [in] what I call common sense gun reform.
This isn't as far-reaching as I'd like to see, but it's better than nothing.
Plus, a revolution in mental health, making sure that if people are having a nervous breakdown, or are suicidal, or homicidal, they get the care they need when they need it. I think the vast majority of the American people can support and agenda composed of those features.
Damnit, Bernie. Again: while America absolutely needs stronger mental health support, linking this issue to gun crime is irresponsible.
On this issue, Hillary Clinton has a much more solid platform, including the removal of the immunity protections that gun manufacturers currently enjoy.
He's not a perfect fit for my beliefs, but he's far from the single-issue, light-on-substance candidate he's often painted to be. As Hillary Clinton has repeatedly stated, the larger danger is from the socially conservative, fiscally irresponsible policies being peddled by the front-running Republican candidates, and I would rather see either Democratic candidate become President.
I support him on healthcare, education and foreign policy, as I've shown. I also applaud his stances on womens' rights, marriage equality, veterans' rights, and reforming the financial sector.
It's probably clear that I'm concerned about social justice issues. But I'm also in business, and I believe these policies directly benefit me in ways that include:
- Creating a stronger safety net, removing some of the potential downside from starting and running a small business.
- Building more prosperous communities across America, strengthening middle class Americans (or as I call them: "customers").
- Creating a more peaceful, more collaborative world, which will open global markets and new business opportunities.
- Strengthening opportunities for diverse voices in business, making America more innovative.
Much of this is inherent to the Democratic platform as a whole. However, one some key issues - like banking regulation and foreign policy - I believe he is the strongest candidate.
I believe a more inclusive, safer society is better for business. I'm saddened by Sanders' stance on gun control, but on every other issue, I am convinced by the picture he paints of a fairer, more prosperous America. Whether he eventually becomes the Democratic candidate or not, I think that picture will be enduring, and I'm excited about the future.
Bernie Sanders photo by Michael Vadon.