Devil Is in Details of Sanders’ Single Payer Proposal

Bernie Sanders health careDouble-digit premium increases have left Obamacare reeling. Despite this clear failure of central planning, some lawmakers think that the answer is for the government to take over the provision of all health care. This would be a mistake.

Senator Bernie Sanders (I-VT), a longstanding advocate of taxpayer-funded medicine, has finally released his single-payer bill to much fanfare from liberal supporters. The rabid show of support by the grassroots left shows that old ideas die hard.

During the 2016 Democratic primaries, experts from across the ideological spectrum criticized the Senator’s plan as too costly and unworkable in practice. With large required payment cuts to hospitals and physicians and tax hikes on the working class, it’s little wonder why support cannot and will not expand beyond Sanders’ base.

The problem with single-payer goes beyond the gargantuan price tag. If the federal government were to become the sole national insurer, medical reimbursement rates would likely be slashed in order to cut costs. Faced with severe salary and revenue cuts, many practices would need to close and “insured” individuals would be left with far fewer options.

A similar dynamic has already taken place in the Medicaid program, where low federal reimbursement rates mean low patient acceptance rates by physicians. This, along with several other unsavory features of federal insurance, leaves Medicaid patients in no better health than before obtaining insurance.

Compared to the wholesale destruction of the American health care industry, the plan’s cost is only one of many problems. Unsurprisingly, Sanders has not come close to finding a way to fund his “Medicare for all” monstrosity.

To understand just how far this plan falls short, taxpayers can take a look at the inconspicuous-sounding “Options to Finance Medicare For All” companion document to the plan itself. Never mind that none of the funding ideas were included in the bill itself; tax hikes on the middle class don’t make for great legislation.

Take, for example, the “4 percent income-based premium paid by households” (pg. 2) that is billed as raising $3.5 trillion over ten years. To make the proposed tax sound more “progressive,” the companion document states that “families of four making less than $29,000 a year would not pay this premium.”

But since only 60 percent or more of households with children make over $29,000, it’s hard to see this tax as anything but regressive. This can only be billed as a “savings” for working families by comparing the tax expense with the current amount of health care premiums paid out by the typical family (stated as $5,277).

But this is a misleading comparison, because it assumes that families will not have to pay for supplemental private coverage once the single payer system goes into effect. Many will choose to do so.

Senator Sanders attempts to wave away this problem by prohibiting “duplicate coverage” under Section 107 of the bill. This language, already incorporated into existing federal insurance programs, exists to keep insurers from selling superfluous plans to customers unaware of the generosity of federal benefits.

But the bill’s architects, likely aware of political problems associated with eliminating private financing, allow for direct private contracting with providers (Sec. 303), so long as the provider agrees not to bill the government for these expenses.

While “physician by subscription” services are rare now, Medicare for All would likely cause these services to proliferate by axing private insurance. In exchange for payment better than the federal reimbursement rate, physicians could allow patients to “skip the queue” and get more immediate medical attention.

We see these kinds of programs emerging in Western European health care systems, where private plans cover basic gaps in public services. Sweden, often hailed as the poster child for government-funded care, has seen a surge in private arrangements in recent years in response to yearlong waits to get cancer treatment.

Britain’s National Health Service (NHS) has an unreliable track record with subspecialty care, prompting patients to use private plans. In addition, the French often pay to get the doctor of their choice and to avoid waiting for treatment.

Given what we already know about Medicaid health care outcomes, there will surely be a lot of gaps in care. Any plan that seeks credibility needs to account for these less-than-stellar scenarios, and also take into account the long history of government cost overrunsthat have come with health care delivery.

In the past hundred years or so, single-payer proposals for the United States have been a dime a dozen. But the devil is in the details, as architects have been unable to avoid regressive tax hikes and dramatic reimbursement cuts.

While Sanders and other single-payer supporters see tax increases as a necessary means to bring about universal coverage, they fail to take into account likely consequences. Americans will likely respond to any gaps in government coverage visa private contracting, forcing large expenditures in addition to higher taxes

But America needs not choose between the failed status quo and an ill-conceived single-payer plan. Multiple other plans have the potential to control costs by eliminating unnecessary mandates, increased competition, and nixing costly barriers to entry. This, not federal controls and pitchfork populism, is the solution to the health-care woes facing America..

From - Economics21.org - by Ross Marchand

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Dolores Adams
5 years ago

We don’t want the government to take over the health care. Look what happened under obamacare. People couldn’t afford the premiums. The government is too big now.

5 years ago

No matter what Sanders says, I always have just one question, Why is Bernie Sanders a U S Senator? The United States has fought several wars against communism and millions of lives have been sacrificed to defend and preserve our United States Constitution, the “LAW OF THE LAND”. every Federal employee and especially members of the Senate, the House and the Oval Office “SWEAR” to Defend and uphold the United States Constitution against all enemies domestic or foreign, so why is Bernie Sanders always saying, acting and attempting to Undermine, destroy and go against what the United States Constitution says should or should not be done.
There is nothing in the United States Constitution that permits or authorizes Federal provided medical care, or even authorizes A Department of Education or Federal nose sticking into our educational systems. People like Bernie Sanders and other like him removed from office because they are violating the united States Constitution and committing a clear act of “Perjury”.

5 years ago

How long can this go on? All the brilliant people we have in this country and there isn’t a solution yet? Amazing!!!!!!!!!!

5 years ago

The Sander’s plan is actually brilliant from the point of the left: Step #1, take Medicare (single payer) coverage away from those 65 and older and extend it to all Americans; Step #2, “suddenly” agree with the Republicans that Obamacare should be dismantled. Voila… all healthcare now single payer!!!

5 years ago

Just require congress to participate in any proposed plan. That will produce the best plan.

Lee McQuillen
5 years ago
Reply to  Mike

Not only must they participate, they must also pay for it without any subsidies or other form of assistance!

Jim Alexander
5 years ago

I can see no reason for the Government to be involved in the insurance business; nor, do I see any excuse for MANDATING/TELLING the “dumb” American to buy health insurance. This is what the Insurance Companies are in business to do; e.g., SELL insurance to those who can afford to select that insurance which they NEED and can budget for. Medicare for those 65 and older and State run Medicaid for the poor and disabled.

I’m certain the next “mandate” will be telling us what foods we must buy at the grocery and what make, model and color of automobile we must buy to fall into lockstep. As Phyllis says: “They shouldn’t be our Nanny.” The Sanders Leftist/Socialist agenda is in full anti-freedom mode.

5 years ago

Everyone needs to remember the story of the baby in Great Britain that the government run hospital refused to allow be taken to another country for treatment that might have helped him even though the parents had the money and doctors and hospitals offered the treatment for free. They wouldn’t even let the parents take the baby home so he could die peacefully in their arms. That is TOTAL government control of your health care and if that is what someone wants then they need to pack up all their belongings and move to one of those countries that already have it. We don’t need it here!

5 years ago

To begin with Sanders should never have been allowed to run he is a socialist and would be the downfall of this country a long with the rest of the liberal socialist and communist the hand outs are killing this country we would end up like Venezuela.

5 years ago
Reply to  Robert


I am afraid that we will end up like Venezuela. The people here are too stupid to care about this. e

5 years ago

Everything of a personal nature – i.e. social security, medicare, medicaid, student loans, etc., is a total mess if not currently, eventually will be. Example, the social security lock-box – the one our politicians stole all the money from to use for more programs they could steal from. I cannot stand the nanny-state mentality.

5 years ago

This article is far too soft on the negative consequences that will result from any national single-payer healthcare system. Stop dancing around the issues and take a definitive stand by outlining all the major downside specifics that have been historically true of all implementations of single-payer in other countries around the world. Right now, the public is being fed a lot of rosy predictions by the left in this country to try to get buy-in. Like its cousin Obamacare, single-payer will NOT be the panacea to all Obamacare’s short-comings. It will be far worse.

By the way, what Sanders is promising is nothing new. He is simply repeating the exact same sales pitch used by socialists in other countries to get their population’s buy-in using all the same talking points. Only after the fact have these people learned the truth. Of course by then, it is impossible to un-do.

The solution is full repeal of Obamacare. From that clean repeal basis, a couple of minor reforms can be made to address the few issues of concern to most of the public. The solution is NOT a tweaked version of Obamacare, with some pieces moved around on the table like a shell game. That AMAC is still pushing a Obamacare-lite proposal, no matter how thinly veiled, is amazing and just confirms where you really stand in this whole debate.

Tom Wilde
5 years ago
Reply to  PaulE

AMAC was created mostly because AARP went full Communist and fell into lock-step with the Left on ObamaCare. The 45 Goals march on!

That’s why I quit AARP and joined AMAC.

Now we see AMAC pushing for ObamaCare light, which in reality is hardly any different than than what they initially claimed to oppose.

Now the question is this. Since AARP went far left and AMAC has begun marching in that direction, where do I go from here?

5 years ago
Reply to  Tom Wilde

Hi Tom,

The primary objective of both AARP and AMAC is to sell insurance and associated insurance by-products (primarily annuities) by collecting a fee from the insurance companies they steer their members towards. They both also collect a fee for the advertisements they post on behalf of their various sponsors. Their political advocacy, such as it is, would appear to be focused mainly on promoting and protecting their primary objective. That is reflected in the so-called “solutions” they put forth on various issues. Both are unfortunately promoting Progressive (Socialist) solutions. AARP is hard left and AMAC is, based on what they’ve proposed on a number of issues to date, slightly less left leaning, but far from what I would consider truly fiscally or constitutionally conservative. Thus I dropped my membership after several years.

If you looking for conservative organizations that actually walk the talk as they say, then there are of course groups like Judicial Watch, Project Veritas and several others that actually stand for both fiscal and constitutional values. The problem is, of course, that none of these other organizations sells or gets you a group rate discount for insurance and insurance by-products. So if you’re primary interest is discount insurance, then you’re stuck with bad choices you probably prefer not to finance with your dollars. If on the other hand, you’re looking primarily for a truly conservative organization t promote conservative solutions in Washington, there are a number of choices out there. You just have to do your homework to filter out the frauds from the legit ones.

Hope this helps.

Tom Wilde
5 years ago
Reply to  PaulE

Actually, I’m not looking for group insurance rates at all. I’m looking for an organization that actually does what it claims to be doing. That is, representing the best interests of seniors in America as in “mature” and “retired”.

Unfortunately the net and the world at large are loaded with groups and individuals that wave one flag with their Right hand and salute another with their Left.

I already subscribe to Judicial Watch and donate when I can. But, therein lies another rub. Donating what we can to help keep them afloat while the Globalist/Communist/Muslims seem to have uncountable millions to throw around.

Guess I’ll just do what I’ve done for 70 years now – the best I can with what I’ve got.

The grimy bottom line is that it’s getting to be a rare thing to find someone in a real position of power and/or influence out there that doesn’t lie through their smiling teeth. (Insert pictures of John McCain, Paul Ryan and Mitch McConnell here.)

Ivan Berry
5 years ago
Reply to  Tom Wilde

Tom, seeing those sponsors for an executive order, the Pro Growth Coalition helped to identify who I will avoid supporting on political grounds. However, to my knowledge there is no seniors organization that does for conservative or Constitutional seniors what AARP does for the progressives. Seems commercial greed trumps ideoligy.
One problem is that the collective can use the dependancy of seniors for organizational purposes. It is difficult to preach independance to a cohort that relies on government for health and retirement with even our savings regulated by government rules of when to and how much to withdraw.
Thus far, my family has not used nor planned to use any AMAC service or benefit. And we have never kept track of who offers discounts nor where. Too much bother for too little reward. Life is complicated enough without adding a bunch of extraneous clutter.

Tom Wilde
5 years ago

When, if ever, are people in this world going to wake up to the fact that government run everything is just one thing – dictatorial Communism.

Ask the people of North Korea how much they like Communism. Ask the people of Russia and Eastern Europe how much they loved Communism before they rose up and threw it off. Ask the people of Venezuela how much they love Communism. But try to catch them when they and their fellow victims in North Korea aren’t out trying to catch rodents for something to eat.

Don’t bother to ask them in Communist China either, right now they’re feasting upon the fruits of that utterly one-sided trade boondoggle/redistribution of wealth scam that Bill Clinton and the Democrat Party foisted on us. Without it the Chinese would be suffering too.

One of the trademarks of Communism is socialized medicine. Medicine of the government, by the government and for the government. Medicine run by government bureaucrats. Medical care rationed and handed out by government decree. Medicine which, as the Liberal Democrats want, has euthanasia as an option.

WAKE UP, AMERICA! It isn’t “Socialism”. Vladimir Lenin once said the only reason for “Socialism” is as a stepping stone into total Communism.

Ivan Berry
5 years ago
Reply to  Tom Wilde

Yes TOM, and they are stepping while we’re getting stoned.
Have another shot, Doc. You are about to become a de facto government employee. That goes for all healthcare professionals as well.
Did you notice that after stating the plan was “single payer” (meaning the government), that they still assumed private contracting for services and additionally talking about “supplimental” mechanisms? So do they mean singlepayor or not? The pundits and the planners are as confused as anyone else. Nobody tells what to really expect, but looking to Europe’s socialized medicine should offer a solid clue: rationing and late term abortion, offered in the sixth or seventh decade of life and for all those termed misfits mentally, physically or ideologically to be determined by some government agency (HUD?)

Stephen Lykins
5 years ago

“This would be a mistake.” Ya think? I think that is a classic understatement.

5 years ago

Government’s job is to protect it’s people. They shouldn’t be our Nanny.

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