Bernie Sanders

The Fiction Behind Sanders' Health Plan

You can't demand more without paying more.

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Credit: Phil Roeder / photo on flickr

Bernie Sanders is a democratic socialist who thinks the United States needs a "political revolution." His plan to replace our health insurance system with "Medicare for All" is in some ways a dramatic break with the status quo. But it rests on an old and thoroughly conventional formula: Promise voters they will get more and better health care without paying for it. 

Simply expanding Medicare to include everyone would be a big enough step. But Sanders' plan is to Medicare what a Tesla is to a Toyota. 

It would encompass "the entire continuum of care," including long-term care and dentistry. There would be "no more copays, no more deductibles, and no more fighting with insurance companies when they fail to pay for charges." In sum: Every person will have everything he or she wants in the way of care and will pay zero at the point of service. 

Contrast that with Medicare, which doesn't cover long-term care or dentistry. It also imposes a deductible for hospital stays and a copay on doctor services. In 2010, the average Medicare recipient spent $4,734 for out-of-pocket costs. 

Such obligations are an inconvenience and a burden to patients, but they serve two useful purposes: reducing what taxpayers have to pay and discouraging care that is only marginally helpful. This approach serves to contain costs. Sanders' change would serve to increase them. 

He argues that his system will be more far cheaper than private insurance because it will cut down on "overhead, administrative costs and complexity." But a lot of private insurers' costs come from scrutinizing claims to prevent fraud, overtreatment and unnecessary treatment. Agreeing to pay all charges without review, as Sanders proposes, is an invitation to be fleeced. 

One reason he thinks the single-payer approach will work so well is that countries like Canada and Britain use it and spend far less than we do on health care. He takes care not to mention one major tool they use to hold down costs: limiting access to procedures that insured Americans take for granted. 

"One in four Canadians reported waiting four months or more for elective surgery, similar to the proportion of patients in the United Kingdom (21 percent) but much higher than in Germany (almost 0 percent) and the United States (7 percent)," the Canadian Institute for Health Information found in 2012. One in five Canadians needing knee or hip replacements has to wait more than six months. 

The Guardian newspaper reported in 2012 that Britain's National Health Service "has come under growing criticism for making it harder for patients to have operations for routine conditions such as hernia, cataracts, grommets, wisdom teeth, or hip or knee replacement, and denying infertile couples IVF." 

Single-payer advocates will argue that such limits are a small price to pay for guaranteeing coverage for everyone. It's a plausible cause that Sanders, alas, is unwilling to make. He would have us believe there will be no limits. 

He's hardly unique in pretending we can all get everything we want for a pittance. George W. Bush did the same thing in pushing a new program of Medicare prescription drug coverage without raising payroll taxes to pay for it. It cost the government $78 billion in 2014—only 15 percent of which was covered by premiums from seniors. 

When Barack Obama proposed the Affordable Care Act, Republicans charged it would hurt retirees by robbing $700 billion from Medicare. Never mind that the health care plan offered by Rep. Paul Ryan, now speaker, included the same savings from Medicare. 

The GOP charge was unfair, but the administration was equally deceptive in claiming that the economies would be wrung out of private insurers and hospitals, at no inconvenience to patients. That's like saying that if you require utilities to take expensive steps to clean up pollution, consumers won't end up paying more. 

Obamacare was also supposed to provide more for less—requiring health policies, for example, to cover an array of preventive services at no cost to the patient. This type of coverage, the president insisted, "saves money, and it saves lives." More fantasy: Rutgers economist Louise Russell has found that four out of five preventive options save less than they cost.

Both parties have long operated on the assumption that, as Oscar Wilde put it, "Nothing succeeds like excess." The United States has the most expensive health care in the world because Americans refuse to take "no" for an answer. Sanders won't ask them to.

© Copyright 2016 by Creators Syndicate Inc. 

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  1. Oh goodie… I’m first. Here goes…

    Steve, do you think that health care costs would go down if we didn’t have health insurance CEOs around? What do those guys do anyway? Let’s say x is the amount of money i pay in taxes for Bernie’s Trotskycare and y is the amount of money that I pay for private health insurance.

    [fingers crossed] if x < y am I an idiot for putting a Ted Cruz bumper sticker on my shit-encrusted 1984 Ford pickup truck?

    1. Well the problem is xy in bernies give everyone all these goodies. Ceo salaries and insurance profits are a drop in the bucket

      Vermont proves it would be very costly. Where were the savings? Why arent they going thru with it?

      Promising more stuff with govt efficiency equals high costs and shitty quality.

      Sorry brah

      1. Ceo salaries and insurance profits are a drop in the bucket

        Not only that, but profits create an incentive to be efficient and to root out fraud. Because government spends other peoples’ money instead of trying to make a profit, it has no such incentive. As a result government is extremely inefficient and prone to abuse. Thing is, socialists don’t care about that. To them it is a moral issue. Profits are immoral, so it is better to have something run by a frighteningly inefficient and wasteful government than to allow some rich person to make a profit, even if the result is worse for the consumer. Same reason why socialists would rather everyone be equally poor than unequally rich. It is better to starve with your neighbor than to eat fast food while they dine on steak.

      2. He’s just applying Marxist Labor Theory of Value to healthcare, whether or not it makes any sense. It’s a religion. They just can’t help it. If something is wrecking something, then it’s the profits, whether or not it’s the profits.

        You can show them how much price fixing, care rationing, or supply reductions go into making healthcare cheap in other countries, but they don’t care.

        You can show them that medicare wastes more in fraud than the entire insurance industry makes in profits, but they don’t care.

        All they know is the evil fat cats and wreckers are ruining everything, whether or not that’s even mathematically possible. And those fat cats must be punished. And if we have to force everyone into a public school version of healthcare, then that’s a small price to pay to screw fat cats.

        He’d give up LTV and adopt a more recent economic model, one that hasn’t been thoroughly debunked for over a century, but that would require thinking new thoughts, and he just can’t do that.

    2. Steve, do you think that health care costs would go down if we didn’t have health insurance CEOs around? What do those guys do anyway?

      CEOs are greedy profit maximizers, and in a free market, that’s a good thing. Their salary, however, is an insignificant drop in the bucket for health insurers and is clearly not the source of our high medical care or insurance costs.

    3. american socialist|1.21.16 @ 1:03AM|#
      “Steve, do you think that health care costs would go down if we didn’t have health insurance CEOs around?”

      What a fucking ignoramus!
      Yeah, shitbag, if there were no CEOs, everybody would just kinda grok what they should do and where money should be spent and incompetent shits like you would fire themselves!

    4. We didn’t buy it when Billy Jack was peddling it, we don’t buy it now.

      https://www.youtube.com/watch?v=DM8RJSegC-Y

    5. Do people actually believe this? Or is this guy just here to troll?

      Also, the idea that administrative and overhead costs would go down under a state run system in one of the most delusional beliefs imaginable, I’m not sure anything has been proven wrong more times than that.

    6. Ah yes, the lovely progressive myth that CEO salaries are a primary driver of prices.

      Here’s a little back-of-envelope example of CEO pay based roughly on my real life. It’s possible you might learn something about scale from this if you pay attention. It’s not health insurance, but I suspect you will find the same basic scale in place in most large corporations.

      My company sells 20 billion gallons of fuel a year, making 100 billion in sales from the fuel plus other stuff. Once they pay their employees and buy the oil they make the fuel from, they make 4 billion. The CEO makes only about a million in salary, but let’s be generous to the “evil CEO” theory and count all his stock options and shit. It’s about 13 million bucks. Definitely more than any evil CEO deserves.

      So if we take that money and give it back to the consumers, we can see that the evil CEO’s salary was causing gas prices to go up by…*drumroll* zero point zero zero zero six cents per gallon. So, if you have one of those newfangled pickups with a 1500 gallon fuel tank, you were overcharged a penny on your last trip to the pump on behalf of my CEO’s evil, wasteful salary.

  2. Naysayers like to use the argument that some people have to wait longer than they like to be treated in nations with universal healthcare, but fail to mention that many people can’t get treatment at all under a capitalist, for-profit healthcare system. Which is worse, waiting a few months for a cheap or free procedure, or suffering indefinitely and likely dying because you can’t afford an expensive procedure?

    1. What procedure might those be? If you are reall dying…how is waiting montha for the procedure going to help that?

      You can get healthcare without health insurance. Also there are obamacare subsidies for plans

      You flat out are talking out of your ass. Stop.

      1. Really and months

    2. How did that cheap or free procedure now all the sudden become expensive?

      calling it “free”? You do realize someone would pay for that right? How generous of you…someone else should be forced to take care of you

    3. Lefty imbeciles like to beat up on strawmen like ‘many people can’t get treatment at all under a capitalist, for-profit healthcare system.’

    4. many people can’t get treatment at all under a capitalist, for-profit healthcare system.

      Funny how everyone needs “free” healthcare just to make sure no one falls through the cracks.

      We can’t just make medicaid better for the poor! We have to give everyone medicare for all! Wait… what a coincidence! That includes me!

      Why, how generous and compassionate.

    5. I prefer to use the argument that you want to force your system of health care values down my throat with the use of government force instead of giving me a choice to participate or not which I will simply characterize as freedom of choice.

  3. My last pay check was $9500 working 12 hours a week online. My sisters friend has been averaging 15k for months now and she works about 20 hours a week. I can’t believe how easy it was once I tried it out. This is what I do..

    Click This Link inYour Browser….

    ? ? ? ? http://www.WorkPost30.com

    1. Bernie Sanders supporters will click that link. You won’t find many here though.

  4. care, cost, etc aside. Do we really think the government could run a huge program like our health care effectively? I don’t. Name one large government program (or even a small one) that is run well?

    I can see costs spiraling up and out of control with ever increasing taxes to everyone.

    I agree our health care system could be way better and costs lower. The ACA did nothing to address actual health care costs, it just requires that everyone have insurance. It helped insurance companies. Note, I do like the rules around existing conditions that were put in.

    Since everyone always says that you can’t complain if you don’t propose a solution….. My take is that costs would go down for everyone if costs for things like malpractice insurance were reduced. We would have to have some way to limit lawsuits (which I think is the root cause of many of our cost woes).

    1. Note, I do like the rules around existing conditions that were put in.

      Why? Those rules may seem “compassionate,” but they put the rest of us on the hook for huge end-of-life care bills for terminally ill people. When “insurance” becomes a “free” money spigot for unfortunately doomed people, prices must go up for everyone, and sharply.

      And putting that aside, people with pre-existing conditions are a financial risk whether we like that or not. Insurance companies were right not to insure them. Nobody likes the extra burdens people with pre-existing conditions face, but life isn’t fair, and their health issues are part of their personal crosses to bear. High-risk insurance plans exist for a reason, and families and communities can help pay for their care if necessary.

      1. It’s a mistake to think that prior to the ACA insurance companies only turned down truly sick people with expensive to treat chronic conditions.

        For anybody over age 50, odds are high they’ve been treated for some illness or disease or perhaps are on some medication (not necessarily expensive) to control something like high blood pressure or migraine headaches, or perhaps high cholesterol. Yes – some of those people are making poor lifestyle choices, but not all of them. Employer-provided health insurance is guaranteed issue — lots and lots of people with one or two issues in their medical history are covered by employer provided health insurance, but prior to the ACA — those same insurance companies routinely rejected applications for individual policies for those people.

  5. Embrace the suck.

  6. Please stop calling Bernie a ‘Democratic Socialist’. He really, really isn’t one. Not that this is a good or bad thing, but it’s like calling Trump a fiscal conservative. He isn’t one.

    Sanders is an economic illiterate who refuses to learn from the past. I can see the appeal, of course, since everyone like’s the idea of ‘free shit’ but as everyone should already realize there is no such thing as a free lunch and anyone that promises you one should absolutely not be trusted to deliver.

    When anyone brings up Medicare-for-all I simply correct them and call it ‘VA For All’ since ultimately that’s what it would be. Go ahead and ask anyone that went through the VA how that worked for them. Spoilers: Not well. The government has absolutely no interest in regulating itself. You generally don’t let the referee play the game, obviously.

    1. Aren’t all Democratic Socialists economic illiterates?

      1. It’s not about the economy, stupid.

        THERE IS AN OLD STORY about two Russian peasants, Boris and Ivan. Both are poor as dirt, the only difference between them being that Boris has a goat and Ivan does not.

        One day, a good fairy appears at Ivan’s hut and tells him that she can grant him just one wish — but that it can be anything he wants. Ivan says, “I want that Boris’ goat should die.” – Thomas Sowell

        1. Jealousy is hardly the basis to a rational free market.

        2. “Boris….always Boris…”

  7. One reason he thinks the single-payer approach will work so well is that countries like Canada and Britain use it and spend far less than we do on health care. He takes care not to mention one major tool they use to hold down costs: limiting access to procedures that insured Americans take for granted.

    In fact, if we spent as much per capita on health care as Britain does, the Medicare/Medicaid budget alone would be sufficient to give all Americans full coverage.

    What that tells you is that Sanders is full of it when he says something like “we need to raise taxes to lower medical spending”. If the goal truly were to reach British levels of coverage with public funding, he could do that without raising an extra cent; the existence of a private market in health care doesn’t keep him from providing universal coverage with government funds. (In fact, British per-capita spending includes both their single payer system and a large private market of supplemental insurance for people who want better coverage than the public system.)

    So, Sanders’ actual goal is to take even more money out of people’s pockets and hand it to doctors, hospitals, and pharmaceutical companies.

    1. This is a good way to put it.

    2. (In fact, British per-capita spending includes both their single payer system and a large private market of supplemental insurance for people who want better coverage than the public system.)

      This.

      Back in the early 2000s, I was part of a team within my company that was tasked with setting up an office in London. We hired local consultants to provide legal and HR guidance. One of the first things they said was, we will need to set up a good healthcare package in order to recruit effectively. In my naivety about their healthcare system, I said, “wait, don’t you have universal healthcare?” They just laughed and said, “Nobody uses the government system alone, for their healthcare.”

      China has been quietly privatizing healthcare, and Canada recently had a their court case clearing the way for private insurance in Quebec. (btw, my wife is in physical therapy, and anecdotally, the number of Canadians coming to the US for orthopedic surgery is definitly increasing.)

      It’s almost like people don’t see that Bernie’s plan for universal healthcare is like Bernie – old, inefficient, and crusty. (with apologies to certain jugglers. )

    3. dont forget the price disparity in medication. im kinda stumped about that one

      1. European health plans keep costs down by making a lot of medication non-prescription (and hence also not covered), and mandating the use of generics.

        Of course, European health plans also impose price controls. For drugs, that hasn’t hurt them all that much because they have been riding on the coat tails of US drug development. For medical services, it has meant that they have increasing shortages of doctors.

    4. So, Sanders’ actual goal is to take even more money out of people’s pockets and hand it to bureaucrats and party functionaries

      FTFY

  8. Holy cats. Socialists must really believe that the laws of economics are written by legislatures and hence can be repealed or ignored without consequence.

    1. Of course they do. Government is their god. It can do anything.

  9. Sanders: “Vote for me and all your dreams will come true.”

    I’m just gonna start referring to him as Pedro from now on.

    1. Sanders new campaign slogan:
      “Yes, there IS a free lunch!”

      Fine print:
      “if we can force your neighbor to pay”

      1. “Government is the great fiction through which everybody endeavors to live at the expense of everybody else.”

      2. Bernieconomics 101

        The rich pay for their own lunch and 2/3s of the poor’s lunch and 1/3 of the middle-class’ lunch.

        The middle-class pay for their own lunch and 1/3 of the poor’s lunch.

        The poor get a free lunch.

        This elevates the poor to the middle class, by freeing up their meager resources for advancement, and thus saves everyone money over time, eventually freeing up the middle-class to become rich(as the number of poor decreases). This positive feedback-loop accelerates the accumulation of wealth, and before long everybody is rich. It only breaks down when the rich and middle-class buy more expensive lunches than they should, and using their wealth to get out of paying for the poor’s lunches.

        /sarc I shit you not. This is exactly the way they think it works.

  10. Carve out a couple “socialist” enclaves and tell them – do whatever the fuck you want! No support from the people outside the enclaves, “period”. Give ’em all the free shit your ideology can imagine – living wage, no CEO’s, free health care, food, housing, no guns, affirmative action, open boarders, a Utopian welfare state, and a different white male in the slave cage everyday . . . the sky’s the limit. Leave the rest of us the hell alone from this delusional socialist idiocy.
    See how long they last. The sad thing is, that when it takes a giant dump on them, they’ll blame . . . Bush (or at least someone else.)
    Let’s try it!

    1. Pretty much been tried. Recent example, Venezuela.

    2. i think that idea is called something like “federalism”. if only it had been invented 18th centurty

    3. Stretching the issue with a health care system to everything else you listed is facetious at best, intellectually dishonest at worst.

    4. Carve out a couple “socialist” enclaves and tell them – do whatever the fuck you want! Let’s try it!

      We have tried that. It has given us San Bernadino, Detroit, California, Flint, etc. and massive demands for others to pay for the debt they created through their own mismanagement.

  11. My last pay check was $9500 working 12 hours a week online. My sisters friend has been averaging 15k for months now and she works about 20 hours a week. I can’t believe how easy it was once I tried it out. This is what I do..

    Click This Link inYour Browser….

    ? ? ? ? http://www.WorkPost30.com

  12. My problem with health insurance companies is not that they make profits…it’s that we are FORCED to buy their products. And there is no real competition among them that would help keep costs down. Why not be able to buy insurance across state lines? Or for that matter, internationally? That would be a freer health care market.

    1. My problem with health insurance companies is not that they make profits…it’s that we are FORCED to buy their products. And there is no real competition among them that would help keep costs down.

      I’m not sure why you phrase this as a problem with health insurance companies, since government is the party responsible for the initiation of said force, and for the creation of regulatory capture within the industry.

      Why not be able to buy insurance across state lines? Or for that matter, internationally?

      FYTW

    2. Nobody was forced to buy health insurance before the passage of Obamacare and the individual mandate. You know, government regulation, not the marketplace. You should at least be in favor of getting rid of the individual mandate, if not most or all of Obamacare.

      1. So, would you agree that if someone doesn’t have health insurance and has no money or limited resources that run out when he/she is sick, that we should just throw them out on the street to die? In a ‘free market’, unless you can find a charitable organization, if you can’t buy something, you don’t get it.

        1. So, would you agree that if someone doesn’t have health insurance and has no money or limited resources that run out when he/she is sick, that we should just throw them out on the street to die?

          Basic health care costs a few hundred dollars per year on average. Good health care costs maybe $1000-2000/year. Even Singapore, a highly developed nation with a good health care system, spends less than $1000/capita/year.

          That means that Obamacare has higher deductibles than it would cost per year to provide coverage to people, and they pay ridiculous premiums on top of that; it is a total ripoff. If people actually saved the insurance premiums they are now forced to pay, they would be financially much better off than they are with Obamacare “coverage”.

          In different words, the current system makes people worse off than they would be with no government involvement in insurance at all. With a free market in health care and insurance, all Americans would be able to afford basic health care out of pocket (even welfare recipients) plus cheap catastrophic coverage.

      2. Nobody was forced to buy health insurance before the passage of Obamacare and the individual mandate.

        That’s incorrect. We all had to pay for Medicare/Medicaid.

        Furthermore, who could act as an insurer, who could provide services, who could manufacture drugs, who could import them, and who could sell them have been tightly controlled by rent seekers for many decades. On top of that, tax breaks for many kinds of health plans means that you were forced to subsidize other people’s health plans, and the only way to get that money back was, in effect, to get your own subsidies in the same way.

  13. People who complain about markets are people who don’t understand how markets ration scarce resources. Worse, they don’t understand *that* there are scarce resources. If people aren’t getting what they want and need, they think it’s obviously because “evil capitalists” are restricting the flow of free goodies that are the right of every citizen to receive. They seem to have no idea where all the goods and services are coming from or how they’re created in the first place.

    1. Sorry, but until there is actually a ‘free market’ in health care, which there is nowhere, market-driven resource allocation doesn’t work. ACA isn’t a free market. The system in the US previous to ACA wasn’t a free market.

      In any case, the health of the nation is a national security issue, not a free market one. And there is enough data to see that most if not all the Western European single-payer systems generate a better overall outcome at half the cost than anything the US has had in place for the past 50 years.

      1. Sorry, but until there is actually a ‘free market’ in health care, which there is nowhere, market-driven resource allocation doesn’t work. ACA isn’t a free market. The system in the US previous to ACA wasn’t a free market.

        So, government regulation prevents a free market from emerging and your answer is more government regulation. Got it.

        In any case, the health of the nation is a national security issue, not a free market one.

        Please elaborate on this because it sounds like complete nonsense.

        And there is enough data to see that most if not all the Western European single-payer systems generate a better overall outcome at half the cost than anything the US has had in place for the past 50 years.

        How, exaclty, do you define “better overall outcome”, and what makes you think everyone else shares your definition?

        1. See my answer below for the answers to your questions (the other commentator here had virtually the same points as you).

      2. the United States spends more public $/ capita than all but 2 or 3 OECD countries. That is PUBLIC by itself..note does not even include PRIVATE. Going to single payer while promising MORE GOODIES is not going to bring the united states anywhere close to those countries.

        What is a better overall outcome?

        1. A better overall outcome: the same or increased average life expectancy than now but at a lower cost (use of national resources, both public and private) than now. That is what the European single-payer countries have achieved.

          Health care is a national security issue. When over 10% of your population is not subject to regular health care, you’re only building a pool where life-threatening diseases can flower and affect the other 90%, crippling the economy and our national security. I wouldn’t trust putting our national security in the hands of a private army for the military aspect. I can’t trust a messed up private health care system (it is NOT a free market in any case) for the long term health security of the population as a whole.

          Show me a real free market health care system in the world that actually works for the whole population of the country where it exists and then I’ll believe it’s possible.

          1. Did you not read? Where are the lower costs coming from? We outnumber those countries $/capita in Public Spending (VA, Medicare, Medicaid) alone without full single payer.

            You do realize being covered is not the same as healthcare right? Your healthcare is a national security issue claim is pure nonsense.

            “Health care is a national security issue. When over 10% of your population is not subject to regular health care, you’re only building a pool where life-threatening diseases can flower and affect the other 90%, crippling the economy and our national security.”

            What are these pools of life threatening diseases exactly that the 10% will affect the 90%? Since the 90% have “health care” wont they be immune? You have been watching too many zombie movies

          2. A better overall outcome: the same or increased average life expectancy than now but at a lower cost (use of national resources, both public and private) than now. That is what the European single-payer countries have achieved.

            We already spend more per capita in our public system than those European “single-payer countries”. The idea that we need to raise taxes or spend more money in the US public health care system in order to achieve European-style efficiency is therefore absurd. Any politician who promises to deliver a European-style single payer system can already do so with the budget he has, and should actually be able to reduce Medicare/Medicaid contributions.

            Health care is a national security issue. When over 10% of your population is not subject to regular health care, you’re only building a pool where life-threatening diseases can flower and affect the other 90%, crippling the economy and our national security.

            That’s total and utter bullshit. About half of our medical spending is on useless end of life care. Much of the rest is on expensive drugs and treatments for heart disease, diabetes, and cancer, costs that could easily be avoided with diet and lifestyle changes. But our current system, including our public health care system, incentivizes the use of expensive (and often harmful) drugs and treatments over cheap and simple non-medical solutions.

  14. Mr. Chapman, 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? Is your only source of information to look at Anglo-Saxon countries like Canada and Britain as the baseline?

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

    Your article is what I would call intellectually dishonest.

    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. Yes, some of the western European countries spend less than we do for healthcare, but not all. Switzerland and Norway spend more (at least as of 2013). None of the arguments I’ve seen comparing European healthcare to ours adequately address the actual cost for individual services which are much cheaper in Europe than they are here. I suspect that if one were to apply European prices to our system, what we spend per capita would be comparable or less. Providing healthcare (read government subsidies) has nothing to do with bringing down the cost. Address the cost first then you can start talking about providing Medicare for all.

      1. The single payer system for healthcare is a comprehensive system. It’s not just focused on payments. Medical school is FREE in Europe (so none of that crazy individual debt). Doctor prices are fixed. Pharma companies can only sell their drugs at a price (cost+) negotiated with the government/healthcare agency, and the price is the same wherever you go in a country.

        Before railing on the European systems, which have equivalent if not superior health outcomes for its population, you should dig deeper and learn how they work before criticizing them. As for Switzerland, a system with which I have experience, it is not really single-payer. The only real stipulation is that basic health care insurance must be provided without generating a profit for health insurance companies. These companies make their money on the additional insurance (which essentially creates options as to what doctor you are allowed to choose).

        1. Profit isn’t what is driving the costs pf healtchare

          What is a health outcome and how does single payer affect this? Have you considered that perhaps they might have better genes, life style choices and a straight up different culture.

      2. This survey says that Norway and Switzerland still spend less per person on health care than the USA. (Interestingly, Switzerland is not single payer or socialized medicine — it has an individual mandate for basic insurance with premium assistance for lower income citizens.):

        http://www.commonwealthfund.or…..ive#?ind=1

    2. here’s the other thing, imagine your kid was dying from some rare, complicated disease that cost a million dollars to cure. if you didnt have the money for it, or insurance coverage, theyd probably die, and that would suck, but if a central authority has to decide how best to allocate medical resources he couldnt get that treatment even if you could pay for it. that would suck a littl more

      1. Show me a case out of France, for example, that proves your point. I lived under that system for years and this never came up. Yours is a fantasy for which there are no facts.

        1. Show me a case where 10% affects 90% with a disease and cripples the economy in the US? Like going forward.

    3. The US public spending per capita (by itself) is more than all but 2 maybe 3 OECD countries. This doesn’t include the private spending. This doesn’t just dissappear under Bernie Sanders plan….that private spending gets converted to public. Seeing how it is the government and the perverse incentives or lack thereof involved, the administration, overhead, and fraud will go thru the roof. Single payer = massive costs, lack of quality, long lines and rationing.

      THE US PUBLIC SPENDING PER CAPITA BY ITSELF EXCEEDS FRANCE’S SPENDING PER CAPITA TOTAL. VERMONT SCRAPPED THEIRS DUE TO HOW MUCH IT WOULD COST

      1. The European systems control the costs. A single-payer system controls the whole chain of the healthcare system, from medical school to doctors’ fees to hospital infrastructure to the price (on a cost+ basis) of pharmaceuticals.

        Vermont hardly had control over much of that chain. That is why it must be set up on a NATIONAL basis, as it is in Western Europe.

        1. Great a crappier VA….awesome!!!

          Rationing, long wait times, unlimited demand, govt administration…what is not to love?

    4. What does life expectancy have to do with healthcare payment coverage?

      1. Easy to answer. What’s the point of a healthcare system for a country other than to make sure people live as long as they can? If two countries’ populations have the same average life expectantcy but one country (i.e. its government and the people) spends twice as much as the other one per person on health care, who has the most cost-effective outcome?

        1. How does single payer make people live longer? Did you account for life style choices, genes and overall culture?

          Live as long as possible…like even if they are suffering or a vegetable?

    5. So if we were to be like those other countries…why does he need to raise taxes? He could just use the existing medicare/medicaid budget to cover everyone since that would equal out the same per capita as the countries you mention

      1. You eliminate all health insurance premiums but the all the resources needed to run the healthcare system are transferred to the control of the government healthcare agency. Obviously the agency needs some of the resources that the old health insurance premiums represented to finance the health care system. In France, for example, the government healthcare agency only needs HALF the resources per person than the US to get a BETTER outcome from the healthcare system (in the form of 3 extra years of life expectancy).

        1. How does single payer give you 3 extra years? What will you say when this doesnt play out?

          So you want a crappier VA…got it.

          How does one offer all these goodies by putting so much restrictions in place as you have alluded to while cutting costs in half?

          keep dreaming

          1. The VA is socialized medicine — the doctors work for the government. Single payer leaves doctors in private practice. Single payer is socialized health insurance, if you will.

            Bernie is promising too much, but single payer with optional supplemental plans could work well — as they do in many other developed nations.

        2. How does single payer give you 3 extra years? What will you say when this doesnt play out?

          So you want a crappier VA…got it.

          How does one offer all these goodies by putting so much restrictions in place as you have alluded to while cutting costs in half?

          keep dreaming

        3. You eliminate all health insurance premiums but the all the resources needed to run the healthcare system are transferred to the control of the government healthcare agency. Obviously the agency needs some of the resources that the old health insurance premiums represented to finance the health care system.

          That makes no sense. The “resources” that the private system uses are paid for by the private system and private insurance premiums. If anything, the private system currently subsidizes the public system, because at the rates the public system reimburses, practicing medicine becomes increasingly unattractive.

    6. The continuing comparisons of a country as large, geographically and socially as diverse as the US with something a country as small, localized and generally homogenized as say – Switzerland, Austria, Germany or the Nordic states never fails to amaze me.

      There are some things that just can’t be correlated between a country the size of North Carolina and a country made up of well over 50 North Carolinas (square mileage)……

      1. You do know the European Union, where single-payer is pervasive, has a population of 508 million? That’s hardly North Carolina. And you do know that it consists of at least 28 languages, right? That’s hardly homogeneous.

        1. You know there is more than 1 country right?

        2. Ah and the world has 7 billion people….single payer would make them all live long! Flawless logic there

    7. If you control for the massive difference in how we define infant mortality and intra-racial gun violence alone, America’s life expectancy shoots past the socialist medicine nations.

      If you REALLY correct the infant mortality stats–and redefine a large chunk of what Europeans call ‘miscarriages’ as what they really are–infant deaths due to poor neonatal care, the numbers for the US look even better–and socialist medicine starts to look horrific.

      Most of the US higher costs stem from 3 things–paying the huge regulatory bureaucracies, the costs of a litigious society in malpractice insurance costs, and covering R & D costs for pharmaceutical companies.

      1. I’m curious. What is the actual difference in the definition of infant mortality? And how does that affect the numbers for average life expectancy in France, say, as compared to the US. Facts please.

        As to gun violence, that has to do with so many non-healthcare related problems that it’s out of the picture. Plus, at around 12-13000 deaths per year related to gun violence compared to a total of over 2.5 million deaths in 2013, it’s by far not the biggest problem nor influence on the average life expectancy. Go see the following link from the CDC website about death statistics in the US in 2013:

        http://www.cdc.gov/nchs/fastats/deaths.htm

        8 out of the 10 leading causes of death are physical care related. One additional cause is mental health related (suicide) and the 10th is accidents. Any of them generate far more deaths than gun violence.

        1. Ah i see you just ignored the infant mortality point. Gee i wonder why???

        2. Ah i see you just ignored the infant mortality point. Gee i wonder why???

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

      You’re making the incorrect assumption that increased medical spending causes increased life expectancy. In fact, increased medical spending and increased life expectancy are both caused by increased wealth. Beyond a certain minimum, increased medical spending is not beneficial anymore.

      Sorry, Bernie Sanders is correct in his views.

      I lived more than half my life in Europe. Bernie Sanders knows shit about Europe, as is evident from his speeches. Sanders is either a liar or an idiot, or a bit of both.

  15. VT proved that he’s delusional, they couldn’t make it work in a highly controlled environment.

    1. Yep they wanted 11% payroll taxes + increasing the income tax…yet for the WHOLE NATION. It will be just 8 pct? And the employers/middle class will yield all these savings while he promises MORE goodies??????

      It is as if progressives/bernie-bots think healthcare costs are due to CEO compensation and profits

      1. It is as if progressives/bernie-bots think

        But they don’t. They emote instead.

    2. Vermont is not the correct example on which to build a single-payer system. It had, and never could have, the control on the whole health care chain that a single-payer system must have.

      The Vermont example is irrelevant except as a case of in what context you can’t build a single-payer system.

      1. How is it irrelevant? They tried to implement and failed due to cost. Keep smoking

        1. Large employer plans were exempt from Vermont’s single payer idea — so it was bound to fail.

          1. Uh no. It failed because they would have had to almost double their tax revenue

            1. And seeing how it was the govt estimates…i am thinking it would have been more expensive than the estimates

  16. H.L. Mencken said this early in the last century, proof of the old adage that the more things change, the more they stay the same. At least in American politics.

    “The government consists of a gang of men exactly like you and me. They have, taking one with another, no special talent for the business of government; they have only a talent for getting and holding office. Their principal device to that end is to search out groups who pant and pine for something they can’t get and to promise to give it to them. Nine times out of ten that promise is worth nothing. The tenth time is made good by looting A to satisfy B. In other words, government is a broker in pillage, and every election is sort of an advance auction sale of stolen goods.”

  17. Poor old Steve Chapman still doesn’t understand (or want to understand) that unlike the cities, counties and states, the federal government is MONETARILY SOVEREIGN.

    This means:

    1. The federal government never can run short of its own sovereign currency, the dollar.

    2. Given #1, the federal government can pay any size bills at any time.

    Given #1 & 2, the federal government does not need to collect taxes in order to pay its bills. Even if all federal taxes fell to $0, the federal government could continue spending, forever.

    So when Chapman says, “(Medicare for All) rests on an old and thoroughly conventional formula: Promise voters they will get more and better health care without paying for it,” he is trying to discredit what the federal government has done every day of its existence: Create dollars by spending

    When someone doesn’t understand MONETARY SOVEREIGNTY, but continues to write about economics, it’s as though someone who has no knowledge of arithmetic is trying to write about calculus.

    It would be humorous except for the fact that Chapman is deceiving (intentionally or not) all those who think he knows what he’s talking about.

    So, it’s sad.

    1. You don’t really understand inflation do you? Why not make the min wage 300/hr or just print everyone billion dollar bills?

      Riddle me this…if it can just print more money no big deal like you claim….why have taxes at all?

      Your statement create dollars by spending makes no sense….where do you think the dollars come from? Why is there currently debt?

    2. Modern Monetary Theory/ Neochartalism is a fun abstract debate, but has nothing to do with actual economics.

      You’re an idiot.

      1. And the widely predicted hyperinflation for Japan hasn’t happened because…….

        And the widely predicted inflation due to QE and our high federal deficit spending hasn’t happened because…..

        The actual economics you must be thinking of is in outdated textbooks.

        1. When are these high deficits going to result in boom town?

        2. The guy asserted that we should have no tax revenues and run 4 trillion dollar deficits. Why not??

    3. Print us all some 1billion dollar bills so we can all be billionaires!

      \WorkedWellForWeimar

    4. Yeah, and the feds gave control of the currency to the Federal Reserve, which has a charter:

      The Board of Governors of the Federal Reserve System and the Federal Open Market Committee shall maintain long run growth of the monetary and credit aggregates commensurate with the economy’s long run potential to increase production, so as to promote effectively the goals of maximum employment, stable prices, and moderate long-term interest rates.

      I’m not sure where “go apeshit, print whatever currency you feel like, and lend it to the government” goes into that.

      Yeah, I’m sure the federal government could go nuts and take the printing press back, but, who cares?

      Even if all federal taxes fell to $0, the federal government could continue spending, forever.

      Not really. Theoretically, with no taxes coming in, the feds could continue printing dollars and spending dollars forever, but, what would a dollar be worth, at that point? Would you want to spend your time busily working printing presses just to earn monopoly money? Even the feds couldn’t spend dollars like that forever: people would simply walk off. There’d be no one to spend money for or with or to. No one would want it.

      Dollars does not equal value. You can print dollars a lot more than you can print value.

    5. This means: 1. The federal government never can run short of its own sovereign currency, the dollar. 2. Given #1, the federal government can pay any size bills at any time.

      Printing money like that simply amounts to taking away money from everybody who already holds dollars. You can kind of get away with that for a while, but sooner or later foreigners are going to stop taking your money and force you to pay in foreign currency. Next, you get massive inflation and then hyperinflation within your own country. Finally, the currency collapses.

      Governments have operated the way you think many times, and it reliably ends in economic disaster.

  18. “You can’t demand more without paying more.”

    Sure you can. Just cut all the profiteers from the system, and spend that money on increased service!

    \thereisafreelunch

    1. You know who else ran on cutting all the profiteers from the system?

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  20. Can i get an example of how and what regarding this claim above that the 10% uninsured will contract a disease and give it to the 90% killing off all them and wiping out the economy?

    Can you show me how single payer would prevent such a devastating disease? Please keep in mind being covered is not the same as having care or that it is good care or that it will do anything for this mythical disease.

  21. Sanders is over promising, but our we should not confuse socialized medicine (i.e. the U.K.) with single payer – which I’d describe as socialized health insurance.

    Cherry-picking data happens on both sides of this topic. Overall health care outcomes are often as good or better elsewhere. We rank better in cancer survival rates but not in many other metrics. To see more: http://www.commonwealthfund.org

    We ration care based on income, individual financial resources, provider network price negotiations with multiple insurance companies that leave consumers out, and a mine field of different insurance coverage provisions – often interpreted differently depending on which clerk at a given insurer is processing a given claim. Our health care spending is 30-50% higher per capita than other developed nations, so it seems that insurance companies do a lousy job scrutinizing claims to prevent fraud, over treatment, etc.

    I don’t want socialized medicine (doctors employed by the government). Single payer leaves doctors in private practice. I believe a hybrid system of single payer + optional supplemental plans would work better than our current system.

    1. We already have this. Medicaid, Medicare, and the VA among other state/local plans.

    2. Dumbass, the 10 biggest private health insurers made 12 billion in profit on last report while the CBO estimates medicare/aid fraud for the same period to be 40 billion. Tell me again how the federal government will reduce costs….you can’t because they won’t. Any sane person with knowledge of the billions wasted yearly in every every single branch of the fedgov knows you are full of shit.

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