Single payer

Bernie Sanders' Health Care Plan Proves That U.S. Single-Payer is an Expensive Fantasy

It's too disruptive and too expensive.

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Domestic critics of single-payer have long charged that the idea is an expensive fantasy. And over the last few weeks, that's basically the tack that Hillary Clinton has taken in pushing back against rival Democratic presidential candidate Bernie Sanders' idea for a single-payer system. Sanders has no idea how to pay for his plan, Clinton said, and, in fact, had not even released a plan at all. Instead, she argued, the best bet for Democrats would be to stick with Obamacare and try to improve it.

On Sunday night, shortly before the Democratic primary debate, Sanders released his plan, dubbing it, Medicare for All: Leaving No One Behind. The plan provides some details about how Sanders' would pay for his plan—through a combination of increased taxes on high earners and fees on the middle class—but rather little else. It is an attempt to prove the critics wrong. And it is a failure in almost every way.

The Sanders plan would require $1.38 trillion—trillion! with a T!—in additional federal spending every single year. That's roughly 8 percent of total GDP. As a comparison, the official cost estimate for Obamacare—which almost didn't pass over concerns about its price tag—when it was passed was about $900 billion over an entire decade.* Sanders is proposing to spend far more than that every single year.

The tax hikes required to pay for this much new spending would be enormous, and while the Sanders plan does its best to place most of the burden on high earners through a slew of income tax hikes that increase the top marginal rate up for 52 percent for income over $10 million, he also adds new taxes on employers and an additional 2.2 percent flat tax on virtually all income beyond the standard deduction (currently $28,800 for a family of four). This is in addition to increased taxes on investment, a big hike in the estate tax, and a cap on tax deductions for high earners. Given that a single-payer plan already failed in Sanders' incredibly liberal, tax-hike-friendly home state of Vermont because of the tax burden it would impose, it is virtually impossible to imagine a plan like this making it through the U.S. Congress.

In the plan, Sanders tries to pretend that the new flat tax isn't really a tax, but an "income-based premium." But in Sunday night's debate, Sanders, when asked, didn't really deny that his plan would raise taxes on middle-income families.  Instead, he argued that his plan would do away with health insurance premiums entirely, replacing them with his new tax, and that the end result would be savings for the middle-class.

There are two problems with this. The first is that those savings only happen if the Sanders plan can hold down costs. But as Ezra Klein points out, the savings imagined in the Sanders plan are extremely aggressive—one might even say completely ridiculous—by any measure, and Sanders provides no details on exactly how he would achieve them.

In fact, he seems to suggest that his system would pay for just about any kind of treatment for any person, which would have the opposite effect. Sanders totally refuses to reckon with the sort of tradeoffs that might conceivably produce some savings, probably because that would entail admitting that the largest savings can only be achieved by denying treatments and restricting care—in other words, by having the government engage in the sorts of behaviors that people dislike from insurance companies. The point is that his savings are totally bogus.

Sanders' defense also reveals another problem beyond his savings: The way he would get rid of private health insurance premiums would be to get rid of private health insurance. That's what a single-payer health insurance plan is: a single, government-run health insurance system that pays all the health care across the country. Now, in reality, some countries with "single-payer" systems also allow for add-on plans beyond what single-payer covers, so a single-payer system wouldn't necessarily outlaw all private insurance payment. But even still, a plan like the one Sanders proposes would entail radical upheaval of the current health insurance regime, with lots and lots of people losing their current employer-sponsored health insurance. 

And the problem is that most people like their current health plans and doctors. This is something that Hillary Clinton understands all too well. The threat of disruption was one of the biggest reasons why the Clinton health care plan she worked on in the 1990s failed. It's why, in order to pass Obamacare, President Obama had to promise repeatedly—and falsely—that if you like your plan, you can keep your plan, despite knowing this wasn't strictly true.

Bernie Sanders' single-payer plan makes no such promise. Indeed, it is essentially a promise that you can't keep your current plan, because the whole idea is to get rid of the current system of health care financing and replace it with a government-run system. Disruption is the essential element of a single-payer overhaul. 

In other words, what Sanders' plan proves is that critics are right, and that single-payer in the United States is an expensive and politically hopeless fantasy peddled mainly by people who are utterly unwilling to contemplate or admit the tradeoffs it would require.

At the same time, the persistence of this fantasy, the success of the Sanders campaign, and the thrust of Hillary Clinton's response—which is basically that the Affordable Care Act is a good start but needs work, especially on cost control—combine to reveal something else: an enduring liberal dissatisfaction with health care law in its current form. To many of those on the left, it seems, even Sanders' deeply implausible fantasy plan is preferable to Obamacare. 

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  1. Go home, Bernie, you’re senile.

    1. How disrespectful! Bernie’s not be insulted like that since Emma Goldman called him a “crazy youth.”

      1. Bernie hasn’t been insulted like that since Mikhail Bakunin stole his college girlfriend!

        1. xD +1

    2. Misguided populism and senility are bad enough; but there is an even stronger reason to avoid voting for Sanders. Consider that if his policies had been in place for the past seven years, it would probably have been more difficult to jail the Dead Sea Troll ? a situation that would have had a devastating impact on the spirit, national mood, and social unity of the United States. See the documentation of America’s leading criminal troll and criminal “satire” case at:

      http://raphaelgolbtrial.wordpress.com/

      1. Nah, i’m good.

        1. I figure at any minute he is going to throw his hands up and just start talking about his roommate’s cousin who makes $12,000 a day online.

          1. I don’t object to the amount of money he makes ? after all, making money online is exactly what democracy is about, right? The Internet is the future of America! I do think, however, that some of the proceeds (gads, $12,000 a day?) should be put aside into my special anti-Troll fund, so we can create more federal and state alert mechanisms and really crack down on some of this rabble whenever they threaten the quiet of our local academic communities with unwanted trigger-speech and inappropriately deadpan “parody” of distinguished deans and department chairmen.

  2. There are true believers, and then there’s everyone with a brain.

    I’ve had 3 “adventures” into the healthcare system this year, each one worse than the last.

    At this point, I’m not even interested in debating it anymore. I just want to punch people in the face. I have cash, so I can get around the bullshit. Other people aren’t so lucky. But that’s kind of the point, isn’t it?

    1. I have cash, so I can get around the bullshit. Other people aren’t so lucky. But that’s kind of the point, isn’t it?

      Based on Canadian system, the point is to make sure cash is no workaround. Connections and social standing are what you need. They usually go side-by-side with cash, but are a good way to exclude gross people who happen to have money.

      Of course, people with cash can go to US instead. That way we can pretend we don’t have a “two-tier system” while having a two-tier system.

      1. Based on Canadian system, the point is to make sure cash is no workaround. Connections and social standing are what you need.

        Of course, this also worked out so badly they had to re-legalize private practices.

        1. Now it gets tricky – unlike Sanders proposal, and any other country I can think of, health care in Canada is provincial responsibility. Which means regulation and laws differ in different parts. So you can have private practice in some provinces, but in those, far as I know, you can’t take patients using public insurance, which everyone has. Ontario, I think, bans private practice all together, some places allow stuff like MRI clinics and similar, where you can take pressure off public system.

          Quebec Supreme Court ruled that private practice is constitutional, despite their legislation, but that ruling is not binding on rest of the country. And then, the fact that feds give money to provinces because income tax means federal government has money, constitution says provinces have responsibility for daily expensive stuff (health & education & policing), so transfers happen, which means now federal govt. can apply the Golden Rule.

          1. Ontario indeed bans it like the good commies they are. Quebec permits it but under strict conditions. Canada’s entire system is way too rigid and doesn’t permit for adaptability in a timely manner.

      2. I have no doubt that this is where it’s headed. It’s not quite there yet, and the contrast is staggering.

        My grandfather is in hospice at home, and has maybe a week left. We’ve been trying to get him some pain relief, and it has involved dozens of hours on the phone, with zero results. Even his primary care doctor of 30 years is coming up with excuses. There are no emergencies with Medicare. Get in line or fuck you.

        One 3 minute call to my doctor fixes the problem, and he’s never treated my grandpa.

        This is the future of medicine in this country. VA and Medicaid for everyone (except for congress, of course).

        1. I, for one, look forward to medically touring Mexico on a regular basis in my waning years.

          1. I was just in Cabo. My wife went in to a farmacia to get some Retin-A, and they kept pushing painkillers on her.

            In some ways, Mexico’s healthcare system is way better than ours.

        2. Sorry about your Grandfather. Hope he’s not suffering too much.

          1. He has 2 kids and 6 grandkids taking good care of him. If not for that, it could be pretty awful. That’s how Medicare is.

            1. Pl?ya Manhattan.|1.19.16 @ 2:03PM|#
              “He has 2 kids and 6 grandkids taking good care of him”

              If that’s all of them, you (and he) are fortunate. In my experience, it’s 2 kids taking good care of him and the third trying to take good care of himself.

              1. Same here! Me taking care of Dad here with what help I could get from hospice, another brother flying in for relief whenever he could, and the other two couldn’t be bothered to pick up the phone and talk to him…. but were happily taking dibs on Dad’s stuff and trying to get an advance on their meager inheritance. This is how it often works.

          2. If Playa regales him with his amazing weekend jaunts, he’s suffering at least as much as the rest of us.

            1. I had diarrhea this weekend. All weekend. True story.

              1. Pl?ya Manhattan.|1.19.16 @ 1:52PM|#

                I was just in Cabo.

                Do tell.

                1. Unrelated. Nothing I had in Cabo was less than 10% alcohol.

              2. I told you orphan meat is hard to digest.

                1. And their blood, while invigorating, is a bit acidic.

                2. Homeless orphan is far too gamey, I’ve found.

              3. Fess up….you had to try some Chipotle, didn’t you?

                1. It’s not really “trying” if you already know the outcome.

      3. and the Canadian system works so well, Canadians come to the US for certain things. When I lived on the Gulf Coast, the snowbirds talked about it.

        1. I believe that Canada’s system has great poll numbers. Everyone loves it! Until you poll just the actual people using the system and not the healthy who are just theoretically satisfied. Then level of supports drops a lot.

          1. This is true. If you’re a 32 yr old mom and the worst health issue you have is getting a script of Amox for the kids’ ear infections, you’re pretty happy with it. Unless of course you actually have a brain and realize that the premium you pay in taxes could have also afforded payments on a new car and an annual vacation. But if you’re an old fart trying to get a hip replacement or bypass, your best bet is if you have enough money to come to the States and pay cash for it. It can be expensive here, but at least it is available.

      4. BUT IT’S IMPOSSIBLE TO CUT IN FRONT OF THE LINE IN CANADA!

        /politician cuts in front of the line.

        Medical tourism is a good business in Canada. I looked into it myself. If only people knew.

      5. To be fair, most universal healthcare systems do allow private hospitals and insurance.

        It’s all a bad idea, of course, but people tend to focus on the worst systems, like the UK NHS and ignore the many less-bad systems that are out there. Most of continental Europe is far better than the UK or Canada.

        1. For routine care, you are correct. However, delving into the system for anything beyond a good case of the flu, one realizes how screwed up it is compared to a relatively open market in the US. Even according to the Swedes, they are now bragging that 9/10 can see a specialist in 90 days and if you need surgery, you can now get it in another 90 days.

          Adding that up, you can see what a great benefit it is to be Swedish when you need to get that bypass surgery – – 6 months from now, presuming you’re still alive [and not that 1 out of 10 that doesn’t]. Conversely, I got into an osteo for non-emergency foot visit in 5 days and 12 days later had the surgery. My brother had to have a stent and got it two days later. Yeah, Europe is GREAT!

      6. Compared to Swiss healthcare, Canada’s ‘system’ is fucking terrible.
        Here they can’t even be bothered to be punctual or polite enough to address you as Mr or M(r)s. Fucking useless twats.

        1. Switzerland has an individual mandate for basic coverage. Dozens of insurance companies compete for those customers for the opportunity to sell them optional supplemental plans (which is how they make profits, since Swiss regulations don’t allow profit for the basic guaranteed issue policies).

  3. Vote for me and all your wildest dreams will come true.

    1. +1 Pedro

  4. On Sunday night, shortly before the Democratic primary debate, Sanders released his plan, dubbing it, Medicare for All: Leaving No One Behind.

    No Human Left Behind. All Lives Matter.

    1. raaaaaacist

  5. The Sanders plan would require $1.38 trillion?trillion! with a T!?in additional federal spending every single year.

    Doubt it. Highly doubt it. Initial estimates on the cost of free stuff are almost always low. Usually way low.

    1. I mean, are they even thinking about all the money that would be saved on overhead?

      1. So it would actually run $13.8 Trillion per year then.

      2. Haha. I always got a kick when proponents say it would say all this administrative/overhead costs. As if the government would not be taking on the administrative roles….and seeing how efficient they are with the VA among other things (sarcasm), i have hard time buying that it wouldn’t be an overhead cost increase.

        1. They somehow think the government would not get bogged down with administrative roles, and ignore that much of the private spending on “overhead” is directed at fighting fraud, which has plagued Medicare for decades.

        2. Yeah. With politics and “accountability” (not to mention the lack of economic incentives to save costs), government involvement never reduces administrative overhead.

      3. Nah, just get rid of Waste, Fraud, and Abuse and viola!!

        1. what is something officials talk about but never do? I’ll take Political Fantasy for $800, Alex.

    2. Costs are always low and benefits are always high with government estimates

    3. On top of that, the “take” from tax increases never meets expectations, especially if the increase is against the wealthiest people. People change their behavior based on the tax code, and the richest people are the ones who can do this most easily and effectively.

      But it’s not surprising to me that progs don’t get it. I remember one popular proposal among some progs I know: huge tax on gasoline, which according to them will reduce gasoline consumption and provide vast piles of money to build government-run choo-choo trains. When I explain to them that the tax can’t do both, they look baffled.

      1. Progs scream when gas prices are low due to climate change
        Progs scream when gas prices are high due to evil oil profits.

        1. Except they will momentarily pause when gas prices are low to congratulate President Obama for making gas cheap.

          1. Haha yea.

        2. Ha, I remember a conversation I had with a prog regarding your latter point, back during the Bush years. He was blaming Bush for the high gas prices, and I asked him “but isn’t that what you want, to fight global warming?” He was honest enough to say yes, but only if the high price was the result of a tax so that the government would get the money.

          1. Did you tell him that .50 to .75 per gallon is all local, state, and fed taxes?

            1. DesigNate beat me. Another question. What is the profit per gallon for the oil companies? I seem to recall it being only 2-3 cents.

    4. Sure, but $1.38T the lowest number they could come up with that everyone wouldn’t laugh at. It really makes you wonder how they got that down from $1.4T though, huh? Now all they have to do is deal with the practical ones like you who understand that no politician ever speculates high when it comes to cost or how much they will tax you for it.

      Of course this doesn’t even include the money necessary to transition. If an Obamacare website whose primary function is putting your name on form PDF and assigning you an application number can cost 2 billion dollars, imagine the cost of switching an entire nation over to an untried system that now doesn’t exist.

  6. Even if it totally replaces medicare and obamacare ? I guess I find that a little surprising.

  7. Instead, he argued that his plan would do away with health insurance premiums entirely, replacing them with his new tax, and that the end result would be savings for the middle-class.

    Why does this post not mention the intermediate step this glosses over: my employer pays my health insurance premiums, and I don’t think they’re going to give me a raise to make up the difference after single-payer is enacted. Even for people who pay part of their premiums themselves, if their employer contributes, this is not “savings” for them at all. I’ll just lose part of my compensation and have to pay a new tax on top of it.

    1. Well, so you don’t have to see the nasty little tax, it will probably be part of the employer’s portion of your taxes.

      1. Well that…. and of course what they call an “income-based premium”. It feels so much better when you don’t call it a tax, doesn’t it? Naturally that will stay at 2% as well. Never let it be said that the government imposed a tax at a low rate to get it in the door and then jacked the hell out of it.

    2. I was watching the debate, and that point immediately jumped out at me. I won’t experience the gain Sanders is talking about, but I get the tax plus shitty government-run health care. Why does he think I would eagerly jump at that?

      1. The payroll tax proposal would be about 2K then what it is spent currently in medicare taxes+ employer plan. And i am no where near the 1%.

        Vermonts 11% payroll tax addition would have been even worse…i suspect it would be closer or even more than Vermonts projections.

        Why would i take that deal?

      2. Honestly, I can’t figure out why no one seems to have brought it up yet. As far as I’m concerned, he’s proposing huge cuts in pay for millions of middle-class Americans.

        1. income inequality resolved. For the win. We can live in equal misery.

          1. Except it wouldn’t do that at all. The rich will still be rich. But the middle class will be a bit poorer.

            1. The rich will be slightly less rich, though, and that’s a step in the right direction!

              1. Yeah, “a step in the right direction”. There’s nothing quite like taking from someone who has more than you to make yourself feel better, right? Envy is almost as attractive as sour grapes. Let’s lobotomize some Mensa folks and cripple some athletes, cuz that feels good too. Bastard marathon runners… fookin genieusses!

    3. Look on the bright side. You only have to pay those nasty taxes until Bernie’s other policies force your employer out of business.

      Once everyone’s on welfare, health care will be free!

  8. In the plan, Sanders tries to pretend that the new flat tax isn’t really a tax, but an “income-based premium.”

    Why?

    1. Roberts will bend over for it.

    2. Because he promised not to raise taxes on the middle class for anything other than funding paid family leave.

      1. So this is a campaign thing, not an attempt to make it ‘constitutionally viable’.

        1. Correct.

        2. That was how the penaltax in the AS A got to be a fine while it was being debated and why the Obama administration was reluctant to argue or was a tax before the Supreme Court.

          Same bullshit, different Democrat.

    3. Because some words sound better. Like when Clinton said that GMO has a bad sound to it, but if you call it “drought-resistant”, yeah everyone will eat THAT!

      Same thing here. Tax sounds bad. Nobody wants to pay “tax”. So change it to “income based premium” and then it’s not so bad anymore. Progressives don’t try to justify their policies, they just rename them enough that the keywords don’t trigger the instinctive reaction, and progressive voters are brain-numb enough that it works on them every damn time.

      “Income based premium” comes laced with the excuse built right into the name. Like bullshit legislation names like, “Solves World Hunger Act”. It doesn’t matter what’s inside, if you vote against that name, you’re voting to keep world hunger, and you’re probably a raaaaacist.

  9. Stupid libertarians don’t understand. Unlike insurance corporations, government doesn’t waste money on immoral profits to rich people. That means government is more efficient than the private sector, because money isn’t lost to greedy rich people. So if government ran the entire health care system, it would cost significantly less to implement since no money would be wasted on profits. Duh. All reality-based people know this.

    1. What is amusing is if the insurance company profits were eliminated, it wouldn’t dent the costs.

      1. *picks up goal posts*

        How is it moral that insurance executives make millions of dollars from denying health care to the needy? Why do you defend that? You are a terrible person!

        *sets goalposts down, lights straw man on fire*

        1. If only there were some Top Men who could back me up on this. In my best Ben Stein…Gruber? Gruber?

    2. No time to find the link, but Medicare loses many times more to fraud and waste than the health insurance industry makes in profits.

      1. Do you got a source for this? This is good.

        1. Found this at forbes, but since it always has a stupid ad before you can get to the story, here it is from Michael Cannon at Cato.

          In a newly released report, the Government Accountability Office (GAO) estimates that, in fiscal year 2010, $48 billion in taxpayer money was squandered on fraudulent or improper Medicare claims. Meanwhile, the nation’s ten largest health insurance companies made combined profits of $12.7 billion in 2010 (according to Fortune 500). In other words, for every $1 made by the nation’s ten largest insurers, Medicare lost nearly $4?

          Actually, it may have been even worse than that: The GAO writes that this $48 billion in taxpayer money that went down the drain doesn’t even represent Medicare’s full tally of lost revenue, since it “did not include improper payments in its Part D prescription drug benefit, for which the agency has not yet estimated a total amount.”

          1. I can’t understand why this report was so underplayed in the media.

            1. Sarcasm right?

          2. Thanks, MJGreen.

          3. Sure, but let’s not worry about efficiency here. The only thing that counts is whether we can flash the salary of an EVIL CEO in front of some reactionaries and piss them off. Far better to turn the whole damn thing over to government and let them squander 4 times as much, triple the price, and put the rest of it on the Federal debt.

    3. A bureaucrat with a fiduciary duty to the taxpayer is a much more effective means of controlling costs than having an employee with a fiduciary duty to their employer. **derp**

      1. A bureaucrat with a fiduciary duty to the taxpayer

        Taxpayers have standing to sue government bureaucrats for mismanagement of funds?

        News to me…

        1. I am not a CPA.

      2. LOLOLOLOLOLOLOL! Right Bubba! Because bureaucrats who are inefficient get fired for poor cost performance whereas corporate employees who don’t perform are allowed to continue their shitty performance at company expense and/or make the company noncompetitive. That’s how the system works, right?

        I think a 40% fraud rate in Medicare pretty much tells you that your head is full of shit.

        1. Do you always agree with someone in such a boorish manner?

  10. But as Ezra Klein points out, the savings imagined in the Sanders plan are extremely aggressive?one might even say completely ridiculous?by any measure, and Sanders provides no details on exactly how he would achieve them.

    Never ever trust when government sells you cost savings by spending money. The ROI estimates will range from the dubious, to the laughably false.

    They attempted to expand a bike-sharing network here, claiming that I personally would save $560 in medical costs if I rode a battery-powered bicycle around the block twice.

    There’s no depth to the falsehoods that a government will spin if given the opportunity to expand its power of the people.

  11. probably because that would entail admitting that the largest savings can only be achieved by denying treatments and restricting care?in other words, by having the government engage in the sorts of behaviors that people dislike from insurance companies.

    This argument just bounces off the thick armor of the single-payer progressive. The insurance companies are doing it for profit and the benefit of insurance company executives. The government does it to save the system, in turn saving you. You literally can’t win with that argument.

    1. Only if the government denies you, you can’t go around them.

      1. And the progressive thinks you should not be able to. Unless it is them.

    2. Businesses ration care to make a profit, and that is immoral. Government rations care for the greater good, and there is nothing more noble than that. Because only intentions matter, one is evil while the other is wonderful. Even if the result is exactly the same.

      1. In reality, it should be the individuals and families rationing care. As an employer, I do not want to be involved in your health care decisions. You work, you get paid. What you spend it on is your own damn business and not my responsibility.

        1. By “Businesses” I meant “Greedy insurance corporations.”

          1. Third party transactions always suck.

            I need to find a cash-only doctor.

            1. They’re gradually getting more common.

      2. Slight tweak: government rationing is rational and scientific, based on a clearheaded and informed evaluation of available resources vs legitimate needs. Business rationing is chaotic and depends only on ability to pay.

        1. Exactly this. Trust institutions.

        2. Let’s not forget that there are literally piles of lawyers waiting to sue your insurance company if they make a bad decision, and they will sue on contingency.

          On the other hand, find me a contingency lawyer who will sue the government [even if they can] that has the full weight of the US Treasury behind it and nobody to answer to in spending every dime they have to in order to win. Of course if it really becomes a problem, then they have the power to make it even harder or even illegal to sue. Insurance companies have no such power.

          Bottom line, it takes no love of big corporations to realize that there is some accountability within the legal system. There is virtually none within the government, and you are literally depending on the same good will that runs the VA, the IRS, and the NSA to protect your bony troublesome ass from its own policies and abuses.

  12. When Ezra Klein says your single payer plan is all “Puppies and Rainbows”….

  13. You know, I’d be willing to make Sen. Sanders and his supporters a deal. They want government provided healthcare? Cool. Let’s open up the VA system to them. If they’re willing to agree, they can get their government healthcare through the VA. The only proviso is that, if they signed on for it, they would only be allowed to obtain medical care through the VA system. The object lesson might well be worth the cost.

    1. I like to make that argument for every messed up thing they want. After all, they’re our “leaders”, right? So they should take the lead and show us how it’s done!

      I did that once on a call-in show on C-SPAN. The guy who was governor of Maryland at the time (don’t remember his name) was demanding that “safe gun” technology be mandated for all guns sold. When my turn came I asked him if, to demonstrate leadership, he would be willing to have his security detail be the first to adopt the new technology. Of course I didn’t get anything approaching an answer (he just repeated his predigested talking points) but it was funny as hell watching him squirm. You know he wanted to say “are you kidding me? I’m WAY more important than you, plebe!”

    2. They will just conclude the right top men werent in charge.

      1. First they’d declare that, no, EVERYONE needs to be involved, so that the proper funding can be allocated and there is the requisite political pressure to make the system work. That will fix things up!

        1. Worked* for Obamacare!

          *citation needed

  14. Just print some more money to cover the costs /derp attack

      1. Which is odd cause they professed to want single payer because it would result in all these cost savings. It is as if you can’t take anything they say at face value.

    1. An example of someone who totally doesn’t understand economics.

      How risky is this? Well, this involves the creation of money to buy goods, not assets. It sounds more inflationary already, doesn’t it. But there are two important mitigating factors here. The first is that by definition, this money printed would be spent overseas. So it’s not obvious how it leads to inflation in the country doing the actual printing unless it leads to a currency depreciation of that country.

      […]

      Today, money creation by central banks is an accepted policy tool.

      […]

      So, can we print money for international aid? I seriously believe the question should be, why not?

      1. Without clicking on the link, I’m guessing that’s neckbeard.

  15. I believe that Sanders’ plan would also cover illegal aliens, so of course the cost estimates are way low. Free healthcare to anyone who can make it to the USA! Yeah, that’ll save the middle class lots of money….

    1. “Free healthcare to anyone who can make it to the USA!”

      Isn’t that basically the system we have?

      1. In effect, yes, but that would make it official.

  16. It’s why, in order to pass Obamacare, President Obama had to promise lie repeatedly?and falsely?that if you like your plan, you can keep your plan

    FIFY

  17. Sanders proposals:

    1. 200 billion a year in infrastructure
    2. Free health care
    3. Free college
    4. Free day care
    5. Free maternity leave for 3 months
    6. More social security benefits

    Anything else? Those will definitely reign in costs while delivering higher quality!!

    1. eh, i think you misunderstand the argument. they’ll deliver higher “equality!!”. who cares about the absolute quality of our healthcare as long as nobody is getting any more or less than anyone else? yknow, cuz all of our bodies and the decisions we make with them are exactly alike

      1. Except for the prog leaders of course!

        1. But, Bernie is a regular guy… I mean, he flies coach, JUST LIKE US! And sometimes he walks to work, JUST LIKE US! He GETS it, man.

          1. Walking is a leisure activity in the US.
            Got to buy $100 under armor suit before you go out and $200 nike treads

      2. Except for the prog leaders of course!

  18. I don’t understand even the basis for Sanders’ argument here. Wasn’t Obamacare supposed to “fix” the medical care system? Didn’t Sanders vote for Obamacare?

    1. In my experience, American leftists have it good. Since our taxes aren’t at European levels, they can just abandon old, unsuccessful programs, and advocate for new ones. “I crashed mah Medicaid, so I just bought anotha.”

      I suspect Europe is so close to maximum maximum taxation that they must compete on actual governance. (Sure, there will still be incompetence and waste, but they have to focus somewhat on delivering goods.)

      1. i hope i die before that happens (spending my twilight years on hold with the department of wellness or whatever sounds boring)

      2. “Since our taxes aren’t at European levels, they can just abandon old, unsuccessful programs, and advocate for new ones.”

        They look away when it comes to corporate taxes for some reason though.

      3. But, that’s just it. They’re not even claiming they crashed their Medicaid. They’re claiming it was brand spanking new and fixed. Yet it’s so broken they need to buy a whole new one???

      4. One other significant difference: Fran?ois Hollande cannot just order some more Euros printed when they are out of funds. Germany would get a little more than pissed off at that and the resulting inflation in their economy if France just can’t get their act together. Therefore, France actually has to work with what cards it has and if their system isn’t working, they have to actually do something or risk meltdown. This is why they are running a top tax rate of 75%. They have over bought and over promised, and now they have to pay for it.

        That wouldn’t fly here, even with the wealthy leftist elite. Therefore, the only remaining course would be to print more, even to the point of toppling the currency.

  19. So was thinking…

    Progs like to say prior to the ACA those without insurance are being denied healthcare. (which insurance is not the same healthcare).

    Anyway wasnt part of the ACA (at least what Obama said) due to the uninsured driving up medical costs and effectively putting the burden on the insured folks? Which means these without health insurance were not being denied healthcare like progs claim.

    So they mandate everyone have insurance with the ACA to address those with no insurance driving up the costs for insured (the problem). This would imply to me that the mandate to address this problem WOULD HAVE TO MEAN THE UNINSURED PAY FOR THEIR OWN INSURANCE.

    But yet they are the ones who were previously uninsured are getting enormous subsidies which drives up the costs for those already with insurance.

    Mind boggling.

  20. the “there wont be any death boards” line of argument is absurd. we could call them something other than death boards, but if you’re not going to be able to make decisions about your own healthcare, somebody’s going to have to. and what’s the endgame? get our embarrassing 100% mortality rate down somewhat?

  21. Why do some national healthcare systems also have people buying private insurance?

    I mean, what’s the point. You already have “free healthcare” right?

    Well, in reality, instead of your own budget constraining your healthcare, it simply becomes the national budget that constrains your healthcare, and yes, its expensive and needs controlling.

    So, how do you keep costs down? Don’t allow expensive meds or procedures that’s how.

    Which is why in Taiwan, you buy cancer insurance privately, because if you want the best, most advanced meds, you have to pay out of pocket. Actually, it applies to more than just cancer, too. Kid can’t take bitter pills? Pay out of pocket for the alternative med that’s not on the list.

    Now, this is not a bad system vs. Bernie’s Canada-like system- it keeps things available, allows a free market to exist in some small extent, etc.

    So why is Bernie banning top up insurance? Because single-payer supporters often are for it not because its better but because they are Levelers and want Bill Gates to wait in line behind Rosa Parks for the cancer drug, so to speak.

    1. This in so many ways. I would be for a two tiered system. The single payer system paid for by the government, and then a wild wild west system where you pay in whatever manner you can get your physician to agree to. It wouldn’t be perfect, but with how much our gov has fucked over our system currently it would be an improvement.

  22. American single payer already exists:

    VA = single payer, NHS style, for vets.
    Medicaid = single payer for poor
    Medicare = single payer for elderly and disabled.
    SCHIP is single payer for kids.
    ACA is effectively single payer if you get enough subsidy.

    What is left is people who make decent money and are employed.

    You’d think they’d be healthier than the other slices that have been removed.

    1. I wouldn’t want to be stuck with the quality of ‘care’ from any of those systems.

      1. Its kind of amazing how many we already have, but the left is still not satisfied.

        I think its mainly because they like having the claim that capitalism/America has poor people dying in the streets. (Never true of course.) You still see lefties bring this up about “how an advanced country can have people dying in the streets. I swear, rename Medicaid something German or French with a new logo, and they’d clap their hand.

        Secondly, some view this as less about health than about radical equality: they have a mental model of Bill Gates waiting patiently in line behind Rosa Parks. Of course, this is not how it ever works, even in single payer, but its a lefty fantasy.

  23. I had someone challenge me, “go read what Bernie says, maybe you’ll learn something”. So I went and I read and I learned something. I learned that after spending 15 minutes absorbing the wisdom of Bernie Sanders I am without a doubt now stupider than I was 15 minutes ago.

    1. I have better buffers. I learned that Bernie is an economic illiterate who should be chased out of the country with a wooden spoon.

      1. I think you misspelled tar and feathers.

        1. I think you guys both misspelled “executed” and “guillotine”.

  24. “Trade offs it would require”

    Hey Peter, let’s say that a single payer system means that I have to pay x dollars in taxes to the government. Let’s say y equals the number of dollars I have to pay a private insurer that is deducted from my paycheck (it’s really y + y1 –the amount that my employer pays the private insurer)

    If x

  25. Sorry…

    “Trade offs it would require”

    Hey Peter, let’s say that a single payer system means that I have to pay x dollars in taxes to the government. Let’s say y equals the number of dollars I have to pay a private insurer that is deducted from my paycheck (it’s really y + y1 –the amount that my employer pays the private insurer)

    If x

    1. In that equation y+y1 will always be less than x, even before quality of service is brought into play.

      1. Yep my X is about 2 grand greater than Y+Y1. Yay!!!!!!!!!!!!!!!!!!!!!

    2. If this were parody it’s be too “on the nose”. Excellent job american slaver

  26. Geesch, f this. Dagny Taggart would throw whoever runs this comment board from the train.

    1. User error, homie. Learn a basic thing for once in your life!

    2. HTML is hard.

      If x < y …. yes? Go on…

    3. There’s always a scapegoat, isn’t there, you racist?

    4. american socialist|1.19.16 @ 2:47PM|#
      “Geesch, f this. Dagny Taggart would throw whoever runs this comment board from the train.”

      Nope, shitstain, it’d be you off the train for wanting to enslave the population.

  27. Comrade Sanders plan would cost me 2 grand more a year than currently and i am not close to the 1%er.

    1. And you’d have less choice, and probably waits for care.

      The less choice thing is serious. In Taiwan, which is pretty decent for single payer, the doctors know that some meds aren’t on the list. If you’re a local they won’t even mention what new drug you could get but its not available, whereas as an American, on several occasions they wrote down the name of a different med to check out when I got back to the States.

      I also had several procedures done in both countries, and the state-run system was more perfunctory and less thorough.

    2. …and i am not close to the 1%er.

      Well, there’s your problem right there.

  28. Sanders = less disposable income. Just like in Canada.

    And Suuderman. Re: ‘Incredibly liberal’.

    I would have preferred ‘marvelously’ if I were your editor.

    *Extra ‘U’ for Fist.

  29. I want am soc consign to the VA Hell system.

    I will pay my own way and never darken their doors.

  30. OT: not going to link

    But “the nation” posted an article blaming the invisible hand of the free market with what is going wrong in Flint.

  31. There is another wild fantasy in single payer. Washington is the playground of special interests and K Street boys. Does anyone think that the K Street boys are going to see $1.38 trillion a year slide through Washington without trying to cut off a piece for themselves?

    Sanders says he against the oligarchy in Washington but yet he is willing to enable them with trillions in taxes. That is just absurd.

    1. Sanders is a fascist, and fascists like handing large amounts of money to corporations that cooperate with them.

  32. =======It’s too disruptive and too expensive.

    That’s a feature of progressive socialism

  33. Sanders provides no details on exactly how he would achieve them.

    What, pixie dust and Unicorn farts aren’t a plan?

  34. I am seriously beginning to wonder how Bernie ever got elected to Congress in the first place. Do people in Vermont get a lot of “free” stuff?

    1. No, he just wants to use taxpayer money to help the taxpayers. Some nerve of him.

      1. Hmm..why is he needed when i could just do that on my own?

        1. You’re too stupid to use your own money wisely. You’ll waste it.

          So, first give it to Bernie. He will squander some, have some friends wet their beaks, and then give you back some healthcare, but you have to wait in line, first.

      2. use taxpayer money to help the taxpayers

        … so half the country will be excluded?

      3. DEEERRRPPP

        Fuck off, Slaver

  35. The US: where owning a machine gun is a right but having healthcare is not.

    1. A couple points…

      1. Health insurance is not the same as healthcare

      2. Not sure automatics are legal

      3. The government isnt providing free guns to everyone. You have a right to bear arms if you so choose, you arent given a free gun courtesy of taxpayers

      4. You can get healthcare without having a singlepayer system

      Please stop

      1. You used facts. You need more appeal to emotion. Think of the children!

      1. I had to sit through a 15 second ad for that.. I hate you.

    2. owning a machine gun is a right

      18 U.S.C. ? 922:

      (o)
      (1) … it shall be unlawful for any person to transfer or possess a machinegun.

    3. You mean we are able to make the choice to own something that affects literally no one, but we don’t have the “right” to have the government to force everyone else to do things for us? That’s fucking bullshit man!

      Also, I don’t think you fully grasp the concepts of rights if you believe they are related to one’s geographic location.

    4. DEEERRRPPP

      Fuck off, Slaver

    5. qbdkusoemv|1.19.16 @ 5:17PM|#
      “The US: where owning a machine gun is a right but having healthcare is not.”

      I have a feeling you think there’s something wrong with that.
      But I got one for you:
      Lefty ignoramuses: Where policy is defined by imbecilic slogans!

  36. “…..so a single-payer system would NOT necessarily outlaw all private insurance payment.”

    That’s what Peter meant to said, I think.

    1. IIRC, Bernie’s plan would ban private insurance.

      1. For real? Dang and he is still banging the it will save everyone money drum.

      2. That’s not very “European”. European “single-payer systems” have large amounts of supplemental private insurance. (Of course, a lot of Europe isn’t even “single payer”, but Bernie keeps lying about that anyway.)

  37. Seeinf the qbdkfjfurn whatever above, i admit i do enjoy when their savior bernie sanders gets berned by reality and seeing his supporters so butthurt

  38. Good one Bernie, prove that the old chrone can be right every now and then, very fucking smooth. You nitwit.

  39. Sanders is also ignoring how single payer nation cut cost – capping doctor’s wages, mandating hours, rationing hours with patients, etc. Doctors in Asia are infamous for recommending surgery for mostly negligible symptoms. They have to find ways to make money.

    Many hospitals that serve the general public in places like Japan and Korea are either notoriously low tech or staffed by incompetent staff. You get enrolled into their public system the minute you’re born there, but it doesn’t mean you get access to quality care.

    You almost certainly have to pay for your treatment if isn’t covered by government. But they do collect enough taxes to do your MRI for 40 bucks, which really excites the Sanders crowd.

    1. “Doctors in Asia are infamous for recommending surgery for mostly negligible symptoms.”

      I had a hernia specialist tell me I needed a hernia operation in Taiwan.

      I got a second opinion: pulled muscle – take some muscle relaxants.

      That was the right diagnosis.

      The opposite happens too. Friend had a swollen jambed finger. No Xray taken. 3 weeks later, my friend saw another doctor: he had broken bones, but now they’d fused, so his middle finger is now, appropriately, in F U position.

    2. Sanders is also ignoring how single payer nation cut cost – capping doctor’s wages, mandating hours, rationing hours with patients, etc.

      Of course he is, because if he simply ran on adopting UK-style single payer, then he could use the existing Medicare/Medicaid budget to pay for it: when spread across the entire US population, it already amounts to more money per person than the UK spends on each citizen, public and private combined.

  40. it is virtually impossible to imagine a plan like this making it through the U.S. Congress

    Even if it got through Congress, I don’t believe the proposed taxes would cover the proposed costs, for two reasons. One, the costs would be higher than expected. Two, the taxes collected would be less than expected. In both cases, the fatal flaw (or one of the fatal flaws) is assuming that people won’t change their behavior in response to the new incentives such a system would create.

    But they would change their behavior, in ways Bernie Sanders can’t imagine.

  41. When it can’t even be made to work in VT, how can it work anywhere?

    1. Vermont doesn’t have enough evil taxpayers rich people.

    2. Vermont was doomed to fail from the outset because it couldn’t control the whole chain of health care production costs, starting with medical school.

  42. I’ve made it my mission to set someone straight whenever they mention “free healthcare”. It’s NOT free; it’s financed through the taxpayers. What they mean is “taxpayer-funded healthcare” (and even then, that doesn’t address the distinction between health insurance and healthcare, but I digress).

    Taxpayer-funded healthcare is not free any more than an amusement park season pass is free since you pay for it once and use the service as many times as you want.

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  44. “the best bet for Democrats would be to stick with Obamacare and try to improve it.”

    With an axe. Behind the barn.

  45. I checked out Bernie’s calculator here for how much he’s going to save me and hilariously even with his own propaganda on how cheap government healthcare is as the basis, he’s getting me four hundred bucks in personal “savings” while hijacking two thousand in taxes from me and six thousand from my employer (read: also from me).

    To be fair, I’m young and single and healthy so there isn’t really a healthcare system that beats cash in my pocket, but I still thought it was hilarious that even under his rosiest numbers I get fucked.

  46. Yea i think that calculator took a lot of liberties with the before and after it probably shouldnt

  47. It’s why, in order to pass Obamacare, President Obama had to promise repeatedly?and falsely?that if you like your plan, you can keep your plan, despite knowing this wasn’t strictly true.

    If by “wasn’t strictly true” you mean “was a flat-out lie.”

    1. Yeah, it wasn’t like he had any hope at all that his lies were true; he lied, he lied regularly, he lied blatantly, he lied knowing full well he was lying.
      He LIED. He was and is a lying piece of shit.

  48. The US already spends more per capita in Medicare/Medicaid than the UK spends per capita for all health care (public and private). Therefore, in theory, full single payer should be easy in the US with no new taxes.

    Higher taxes isn’t about paying for health care for Sanders, he wants to raise taxes because he wants to stick it to people with higher incomes and he doesn’t want to pick a fight with doctors and pharmaceutical corporations.

    1. Medicare doesn’t control the full chain of health care production. Of course it’s going to be more expensive per person.

      Medical school is virtually free in Europe. Pharma prices are negotiated on a national basis at cost+ with the same price wherever you go. Doctor’s fees for the same procedure are virtually the same with any doctor.

      Yes, single-payer means price control. But the evidence is that the Europeans have found out how to do it at HALF the cost with the same or better result (the average life expectancy of the people).

  49. But if we would all work according to our abilities and only take according to our needs…. Oh wait. That’s been tried. It doesn’t work in large, complex, modern societies.

  50. “…single-payer in the United States is an expensive and politically hopeless fantasy…”

    Yes, it’s amazing that other countries pull it off without destroying themselves. Even more mind-boggling is that they often enjoy a higher standard of living. How can this be? And, you’re certainly correct to say that it’s a “politically hopeless fantasy”. Congress is in no mood to do anything. Unless it’s something their paying customers need done – which is only right and proper!

    “…a plan like the one Sanders proposes would entail radical upheaval of the current health insurance regime, with lots and lots of people losing their current employer-sponsored health insurance.”

    That would be incredibly disruptive, and many Americans would be upset. Then again, why would you need private insurance if you’re covered for everything already? Nevertheless, disruptive! I, for one, would miss those clever devils in the insurance industry.
    But why worry? The two parties will, in their wisdom, make the choice for us, and Bernie won’t be one of them. You don’t expect people to “throw away” their vote, simply because they think there’s a better candidate than the two they’re given? That’s why the mainstream media ignores Bernie for the most part. You should do the same, lest you confuse the voters.

    1. A couple points:

      1. The US public spending per capita is by itself greater than all those other countries without full single payer

      2. What do you mean by a higher standard of living? With respect to what?

      3. Covering everything would not save the United States money.

      4. The insurance industry profit margins if even eliminated wouldn’t make a dent in the health care spending.

      5. Vermont scrapped their plan due to costs.

      1. 1. The issue is the use of total national resources, both public and private. The allocation of national resources, which are limited, is the heart of most free market (private resource allocation) vs. government (public resource allocation) debates. Concentrating on just one, public in your case, is only looking at part of the national resource problem, not the problem as a whole.

        As a whole, it’s evident that the Western European countries are doing a much better job with their health care systems (as measured by average life expectancy divided by total healthcare costs) than the US.

        2. Countries with a longer life expectancy generally have a higher standard of living (free vs. work time, measures of general satisfaction, etc.). If we agree, without going into a detailed debate, that Americans in general have the same standard of living as the Western Europeans, then again we see that the Europeans have a better health care system than the US.

        3. The Europeans do it at HALF the cost of the US per person, and they cover everything. Of course they’ve saved money.

        4. Who cares about a single industry? Whether they should exist or not should only be based on efficient resource allocation. The current system is far too expensive than the alternative.

        5. Only a NATIONAL health care systems can control the full health care production chain. Of course it was going to fail. It’s an irrelevant example except how NOT to do it on a small scale.

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  55. See, we don’t have medicare for all because Hillary Clinton is a realist, and knows better than to fight a futile struggle. Bernie isn’t a realist. Krugman told me so.

    After the election, we’ll switch back to the “republicans won’t let us have medicare for all” meme.

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  59. Mr. Suderman, have you ever lived in a Western European country? Do you have first-hand knowledge of how good or bad their health care systems are? Have you actually looked at the level of expenditure for the entire country is per capita for their health care systems?

    I seriously doubt you can answer ‘Yes’ to any of the these questions.

    Your article is what I would call intellectually dishonest. Furthermore, just because something is ‘disruptive’ doesn’t rule out the fact that it may actually be effective.

    There are two simple metrics to measure if a health care system is efficient and leads to the desired outcome. They go hand in hand. In fact, the final metric is the proportion between the two.

    Here is the final metric: (Average national life expectancy) divided by (national health expenditure per person)

    The main objective of a health care system is to achieve a high if not increasing life expectancy. The only constraint is how much you spend per person to get there.

    The result is simple. The United States spends twice as much per person for an average life expectancy 3 years lower than France, Italy, Spain, Germany, etc etc etc. All Western European single-payer systems.

    Check this out to see the graph. It’s from the OECD.

    http://www.businessinsider.com…..ing-2014-3

    Sorry, Bernie Sanders is correct in his views.

    1. You think France has single-payer health insurance? Germany?

      Non. Nein.

      I’ve used health systems in Europe. The UK with its nationalized system probably represents health care as practiced in the US in the 1970s. Maybe 1980s by now.

      France has an excellent health-care system, one of the best in the world. Private health insurance is an important part of the system. Try taking it away from the citizens. Molon labe, monsieur.

      Germany? Oy. Very much the opposite of single-payer.

      None of this means, however, that the US has a “good” health care or health insurance system. There are many excellent models in the world. I wish we would try to copy them. None of the ones we should want to copy is single-payer.

      1. The addition of ‘mutuels’ in France is certainly known to me. I lived under the system for a number of years. However, the way the whole system is organized, dominated by the ‘Securit? Sociale’ and with free medical schools (i.e. virtually free tuition for the students), controlled medical costs (doctors fees, hospitals, pharma), and birth to death medical planning (try letting a childe get obese or forgetting your child’s vaccines in France, you’d be in serious trouble), the overall system is superior to the United States given the life expectancy is already 3 years longer at HALF the cost.

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