This past week, Sen. Bernie Sanders introduced a health care bill that includes a transition over several years to a fully single-payer “Medicare-for-all” system of health insurance in the U.S. Predictably, conservatives and many in the mainstream media jumped all over the idea, suggesting it would bankrupt the country in short order.
“How are you going to pay for a $32 trillion program?” many of them asked, feigning incredulity.
How we pay for things is always a good question to ask, and Sanders has put forward several options for doing so, the most likely being through a payroll tax just as we currently pay for Medicare.
But the suggestion that a single-payer system of health coverage is too expensive is, without a doubt, the single most inappropriate criticism of the concept. The reason that Americans should seriously consider single-payer is because it would be, by far, the least expensive option for providing health care to all our citizens.
First, let’s take a look at that $32 trillion figure, which is a ten-year cost estimate, not an annual expense. That number came from a 2016 analysis of a vague outline of a single-payer bill that Rep. John Conyers has had in the legislative hopper for years. Sanders disputes the number, pointing to a number of savings that his bill would achieve through reducing the vast administrative bureaucracy associated with insurance billing. It also includes a provision for negotiating drug prices with pharmaceutical companies. In the wake of the kind of price-gouging that has become rampant in the drug industry, this is long overdue.
The analysis of the Conyers bill also assumed that states would effectively end their funding of health care programs. But that is far from determined at this point.
So the $32 trillion figure is suspect from the start.
But the subterfuge at play by critics of single-payer is far worse than a dispute over the cost of a Medicare-for-all system, because it fails to consider the cost of our current system of health care. The U.S. spent $3.4 trillion on health care last year and the Center for Medicare Services projects that figure will increase by 5.5 percent annually over the next ten years. You could do the math yourself, but I already did it for you… that equals total spending of $49 trillion over the next decade. Suddenly, $32 trillion doesn’t sound so bad, does it?
Would extending Medicare to cover all Americans require a substantial tax increase? Of course.
But what critics fail to inform the public is that those tax increases would be far less for 95 percent of Americans than what they would save from no longer having to pay insurance premiums, co-pays, and deductibles. Keep in mind, Medicare-for-all, isn’t something that would be added on top of our current system. It would replace the current system of private insurance. Extending Medicare to everyone simply changes the way we pay for health insurance, and it would substantially lower the overall cost. It is also comprehensive, meaning it would provide coverage for dental, mental health, and prescription medication, without any deductibles.
It would also insure all Americans. Lest we forget, an estimated 28 million Americans still lack health coverage even under the Affordable Care Act. Behind the basic economics, there is also the moral argument for universal coverage, which Sanders plan would provide.
Will Sanders bill become law anytime soon? Probably not. But the introduction of the measure, which now has the backing of a third of Democratic senators and more than half of Democratic members of the House, has changed the nature of the debate. For too long, the Democrats have compromised their position from the start of every policy debate and have ended up looking weak and ineffectual to most Americans. Had President Obama proposed single-payer back in 2009, the GOP would have considered a compromise like Obamacare—which retains the inefficient, private system of health insurance— a great victory.
And Sanders has already offered a fall-back position, which is the establishment of a public option that individuals and businesses could buy into. This would almost certainly provide much better insurance at lower cost, so it would eventually get us to single-payer through personal choice, as businesses and individuals opt for the superior product. The downside of this approach is that it wouldn’t wring as many administrative savings from the system, at least initially.
But by putting forward the ideal, you’re more likely to obtain a better compromise. Republicans have known this for years, but it’s a strategy that seems to have escaped the Clinton wing of the Democratic Party. They offer up milquetoast, Republican-lite policies and then wonder why their base is constantly in an uproar and their voters sit on their hands come Election Day.
There’s a reason that Sanders is the most popular politician in America. He doesn’t put his finger in the wind to decide what’s right. He’s pushed to make life better for average Americans for his entire political career— and introducing Medicare-for-all is just one more example of that.
And Sanders’ bill is gaining support, including from Minnesota Sen. Al Franken. So far, Sen. Amy Klobuchar has yet to sign on. I’m not sure what she’s waiting for.