Medicare for All

Bernie Sanders Thinks Medicare for All Could Cost $40 Trillion

The cost of single-payer would dwarf the price of Obamacare.

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When thinking about the cost of health care legislation, it's helpful to put the numbers in context: The final cost estimates for Obamacare, which passed in 2010, came in around $940 billion over a decade, and the legislation was structured in a way designed to move some spending outside the 10-year budget window in order to keep the cost under $1 trillion, which was generally considered the threshold of political acceptability. Even amongst Democrats, a trillion-dollar health care plan was just too expensive. Former Vice President Joe Biden's recently announced plan to expand Obamacare comes in around $750 billion over a decade—which, at more than three-quarters the cost of the initial legislation, makes for a relatively pricey fix. 

In contrast, estimates from organizations across the ideological spectrum have pegged Bernie Sanders' single-payer health care plan, Medicare for All, at around $32 trillion over 10 years. The vast gap between the cost estimates reveals the dramatic difference in scale between the Obama/Biden health care plans and Sanders-style single-payer, and suggests how radical and expansive Democratic health care policy has become over the last decade.

And Sanders appears to think the cost could be even higher than those estimates. At a Washington Post forum, he said that he expects his plan would cost somewhere between $30 and $40 trillion. And then he defended the price tag on the grounds that it would actually be cheaper than the alternative of letting today's system, or something roughly like it, continue. 

"Somewhere between $30 and $40 trillion over a 10 year period," Sanders told the Post's Robert Costa. "What the most serious economists tell us, that if we do nothing to fundamentally change the healthcare system, which is what Joe [Biden] was talking about, keeping it as it is, we'll be spending something like $50 trillion over a 10 year period."

Single-payer supporters often make the argument that their plan, which would eliminate virtually all private insurance and rely on the government to finance the vast majority of health care services in the country, would cost less than maintaining the current mixed public-private system. 

There are several things worth keeping in mind about that claim. The first is that what they mean when they say single-payer would cost less is that total health care spending would be less overall; the cost to the government would be far, far higher than it is today, as all of the spending that now flows through private payers would move onto the government's books. 

And it's not at all clear that single-payer would actually result in reduced overall spending. The studies that have attempted to estimate the cost of Sanders' plan have typically accepted at face value the assumption, built into his proposal, that the new system would maintain today's Medicare rates for health care services. Those rates are, in many cases, substantially less than what private insurance pays. One estimate concluded that providers would face cuts up to 40 percent. Paying those rates everywhere would almost certainly cause substantial disruption to the provision of health care, especially at first. Some hospitals, especially facilities that serve the rural poor, would almost certainly shut down or drastically reduce their services. 

Which is why it is plausible, perhaps even likely, that those rates would not be sustained over time. And if Medicare's pay rates were increased, that would eat into or eliminate the supposed savings. Indeed, in Maryland, the one state to pay equalized rates for all hospital services, Medicare pays far, far more than it typically does elsewhere

Sanders, meanwhile, has already demonstrated that he is willing to spend more to keep hospitals afloat. He has complained about potential hospital closures he fears would reduce access for the poor, and yesterday he proposed a $20 billion bailout fund for struggling hospitals, many of which have a patient population that is heavily reliant on government payers like Medicare and Medicaid. Sanders wants to use government money to bail out hospitals that are struggling because they rely too heavily on government money. 

Sanders can't have it both ways. He is either advocating for a plan that would result in a dramatic curtailment of health care services, especially for the rural poor, or for a system that costs far more than the sky-high price tag to which he has now admitted.

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  1. Free: sacrifice quality, availability and innovation – get a never ending increasing cost to taxpayers.

    Single payer: sacrifice quality, availability and innovation for the mirage of price control.
    With single payer there is no real price discovery.

    1. This is the party / idiocy that Reason is supporting ?? Just because they hate Trump???
      Nothing the Dem’s / progressives are supporting outside of open borders and pot legalization is remotely Libertarian.

      1. Reason is supporting who now?

        You realize that you can dislike Trump and not support Democrats at the same time?

        1. Wrongo, buddy boy, dislike and like are zero-sum games. There’s only so much dislike and like in each of us, and if you like one party, you must dislike the others.

          1. Like and dislike are nonbinary, I can dislike one person, and have a lesser or greater amount of dislike for another

            1. Like and dislike are nonbinary

              Just like male and female!

          2. Ah, I guess the idea of a “third” party is a myth, then?

        2. If this country worked correctly Bernie would have died in federal prison long ago.

        3. You realize that you can dislike Trump and not support Democrats at the same time?

          You realize you can dislike Trump and still recognize that he is a political centrist and politically far better for the country than any of the alternatives?

    2. Free: Get nothing*

      1. Free: Taxpayers get fucked.

        1. Single payer*: Taxpayers get fucked

          1. Yeah, but it will cover any STDs you get in the process.

    3. Economies of scale apply to everything but medicine. A layer of parasititic paper-pushing insurance companies reduce costs and congress-mandated barriers to market help a free market. Got it.

      1. How genius! Since there is no paper-pushing layers in the federal government, single payer is the only way to success!

        1. I hear that “no bureaucracy!” line from so many of my dumb friends. I then ask them what the number one complaint is about care from the VA. Answer: bureaucracy.

  2. This is why I have never bought into the doomsayers who think single payer is inevitable; the government is broke. There is just no money for it. The Democrats one chance at single payer was in 1993 with Hillarycare. That was a true single payer system that made it illegal to buy your own healthcare. In 1993 the national debt was low enough and with the end of the Cold War, they could have done it. But now? There is just no money to do it. Single payer is never happening.

    1. god i hope you’re right

    2. “This is why I have never bought into the doomsayers who think single payer is inevitable; the government is broke. There is just no money for it. ”

      John, that’s cute. You know who was really, really broke? The Russian government in 1917 and the German government in 1933.

      1. No no no. You’re doing it wrong. You’re supposed to leave the question open ended. Let me demonstrate.

        You know who was really really broke?

        1. Owen Hart?

          1. A bit soon.

        2. Humpty Dumpty?

          1. shit i should scroll first sorry.

          2. HD was surely a Democrat…

            ‘And only one for birthday presents, you know. There’s glory for you!’

            ‘I don’t know what you mean by “glory”,’ Alice said.

            Humpty Dumpty smiled contemptuously. ‘Of course you don’t — till I tell you. I meant “there’s a nice knock-down argument for you!”‘

            ‘But “glory” doesn’t mean “a nice knock-down argument”,’ Alice objected.

            ‘When I use a word,’ Humpty Dumpty said, in rather a scornful tone, ‘it means just what I choose it to mean — neither more nor less.’

            ‘The question is,’ said Alice, ‘whether you can make words mean so many different things.’

            ‘The question is,’ said Humpty Dumpty, ‘which is to be master — that’s all.’

            1. The question is, do you want other people to understand you?

              Those that keep re-defining words _intend_ to keep others confused about what they are actually saying and doing.

        3. Humpty Dumpty?

    3. I hope their attempt at it causes the backlash that brings back McCarthyism and destroys the progressives.

  3. yeah but he’s talking about taking total control of the entire Insurance Industry an Industry that took in *checks notes 1.2 trillion in premiums last year. so like that will account for like 12% of the yearly outlays.

    1. also that includes personal property premiums and such so you can probably reduce that by at least half. Bottom line is your talking about soaking everyone for thousands and thousands of dollars.

    2. Obamacare was a modest proposal compared to what Sanders is proposing. The Democrats couldn’t pay for Obamacare much less make it work.

      1. Sanders Idea might work if they closed every department and just focused spending on this one thing. Actually that would be a vast improvement over the current status quo. But healthcare would be a horrific hellscape with the entire industry going black with under the table payments.

        1. That is why I don’t worry too much about all of the projections that have Social Security eating up most of the federal budget. If the federal government is going to spend money, and it is clear it is going to, spending it by sending money to old people is a lot more benign than pretty much anything else they could do with the money.

          1. *narrows gaze* That’s exactly what an old person would say.

        2. That’s actually where Canada is headed. Health care spending is so out-of-control that it’s starving every other government department on some level or another, esp at the provincial level. Whether that’s a good thing or a bad thing depends on one’s perspective, I suppose.

          1. It’s okay. They’ve started to do what the NHS has been doing: eliminating routine surgeries, delaying nonelective surgeries as long as possible, denying to treat conditions when it’s too expensive or the patient is too old, and delaying chemotherapy treatment for cancer to the point that it causes a notable increase in mortality rates.

        3. The bottom line with pretty much all these proposals is that none of them ever engage the actual *cost* of healthcare. This is a country with about 350 million people and rising, and healthcare costs have been escalating at about an 7-8% annual clip for decades now. It used to be, even with all the employer-provided healthcare plans out there, that you could still afford to pay for a lot of basic services out of your own pocket, even in emergency room visits.

          There’s been no real thorough examination as to the root causes of healthcare cost increases, probably due to the fact that taking the cost averages back down to levels as recently as 15 years ago would likely result in an instant recession. So there’s no real incentive to fix things other than do nothing and watch costs continue to exponentially increase, which has been the Republican strategy, or claim that a fantasy economic system like MMT will provide sufficient funding without nuking the economy and the entire healthcare industry to smithereens.

          1. “There’s been no real thorough examination as to the root causes of healthcare cost increases, ”

            I don’t know where you get this idea, but it’s not true at all. Kaiser Health, Commonwealth Fund, CATO and the Heritage Foundation have all analyzed this for decades.

            The disparity in pay comes down to a handful of reasons.
            1. We pay the lion-share for medications, literally subsidizing costs for the rest of the world.
            2. Obesity has a ton of knock-on effects that create chronic conditions and the USA has a very high obesity rate (when controlled for obesity rates, infant mortality rates are on par with the rest of the world and mortality for adults is better than Japan)
            3. We use far more diagnostic tools and patients are much more likely to use newer devices and tests in the USA than in other nations.
            4. We pay our medical staff very well (an RN in the US makes $65k on average, an RN in the UK’s NHS makes $22k on average) and do a much better job of maintaining low patient-to-nurse ratios (US typically has 4:1, although this is not always the case as ICU can be 1:1 or 2:1 and some hospitals may have 6:1; the UK’s NHS recently advised an 8:1 ratio, but stressed that this was merely a guideline and that ratios could be higher if demanded)

            So, really, that’s it. High med prices, lots of diagnostics and using new tech, high obesity rates equate to high rates of chronic health conditions, and we pay our health care workers well. Hospitals in the USA tend to be renovated more and there are higher rates of administrative costs, but those wind up being pretty minor when looking at what makes up the bulk of expenditures in the USA’s health care system.

            In order for Braindead Bernie’s plan to work, you’re going to have to see cut backs in some or all of those areas.

        4. So much easier to make the progressives leave.

  4. OT:
    If you define racism as the belief that physical characteristics cause you to be superior or inferior to others, then isn’t calling yourself “a person of color” a racist statement?

    1. I don’t see where calling yourself a “person of color” is by itself a claim of racial superiority.
      Claiming that being a POC gives you some special insight or ability probably is racist under your definition.
      I find the “person of color” description pretty stupid. It’s bad enough to make your race the central part of your identity. But to define yourself based on not being part of one particular race seems even more ridicuous.

      1. “But to define yourself based on not being part of one particular race seems even more ridiculous.”

        That is why the POC label is racist. It specifically is aimed at excluding one specific group, white people. It is way of ‘othering’ white people from everybody else. Basically they are saying “you can’t sit with us.”

        1. That’s one side of it. It also just maintains the same racial separation supposedly imposed by the evil white people. It’s the supposed anti-racists who keep the “one drop rule” alive.

      2. “But to define yourself based on not being part of one particular race seems even more ridicuous.”

        Person of color doesn’t not necessarily define one as being a member of one particular race. A person of color may have parents of different races, both of which feature the dark skin that Americans find so irresistible. Defining oneself as a person of color glides over the complicated question of ancestry, and targets what is most important for Americans – skin color.

        Usage of the term is probably bad for Republicans, so it’s no mystery that the Right dislike the term. Race is normally most profitably used to divide people and set them against one another. But the phrase glides over race and tends to bring people together – the Catholic from Mexico and the Muslim from Palestine: different yet both persons of color. It’s an example of the Left’s emphasis on inclusivity.

        1. “Everyone but white people” is definitely inclusive.

          1. I’ve never seen a ‘white’ person. Even albinos have some color about them. Like it or not, everyone’s skin has a color. Why white people would insist otherwise is understandable, not wishing, for the most part, to be lumped in with people of Asian, or worse, African ancestry.

            1. Acting like an obtuse idiot isn’t refuting his point.

              1. I am just rejecting his race card.

            2. That’s stupid. No one uses the term that way.

              1. Isn’t stupid the best response?

            3. I agree

              Race is a myth.

        2. Person of color doesn’t not necessarily define one as being a member of one particular race.

          And I didn’t say it did. I said it defines one as NOT being a member of a particular race (i.e. white people).

          1. ” I said it defines one as NOT being a member of a particular race (i.e. white people).”

            I think you are wrong. Obama is a person of color. But he is mixed, half white. It’s the color of his skin that makes him a person of color. His wife, both of whose parents are black, is no more a person of color than her husband, despite being vastly ‘less white’ than her husband.

        3. Person of color doesn’t not necessarily define one as being a member of one particular race.

          AOC is a white Caucasian woman who happens to be descended from Spanish-speaking Conquistadors. In what possible sense is she a “woman of color”?

          1. “be descended from Spanish-speaking Conquistadors.”

            There were no women conquistadors. Any conquistador children were born of Nauhatl speakers, Mayans, Aztecs, Tlaxcalans, etc. You might want to look into the conquest. Cortez had a partner, La Malinche, from somewhere in Yucatan, I believe, a translator, and constant companion and confidant to Cortez. She was given to him by a local chief as a peace offering. Aztecs thought she was a goddess.

            1. Oh so the families of Conquistadors didn’t benefit from “Conquistador Privilege” and their positions relative to native people was equal because the were poor oppressed women?

              1. “Oh so the families of Conquistadors didn’t benefit from “Conquistador Privilege”

                They did. Not only the conquistadors, but also the Tlaxcalans without whose assistance, providing Cortez with armies vastly exceeding his own, the conquest would never have succeeded.

                As an aside, you could benefit from an editor. Assuming you bother to read what you write before you post.

      3. And saying ‘colored person’ is somehow offensive.

    2. Silly. Only white people can be racist. POC can only be proud.

  5. “”and rely on the government to finance””

    And they are wrong right there. It’s the taxpayer that will finance. They will be financing their own healthcare via taxes.

    The states that have looked into found out that it costs as much as their entire current budget. The democrats in NY state can’t get it passed on a state level due to the cost.

    1. You misunderstand. Bernie will pay for it by using Modern Monetary Theory to print away all of our worries. Some might say that it will devalue our currency and send us into a Zimbabwean-like catastrophic economic collapse, but AOC has convinced me that we can just print our way out of that, too.

  6. Look, I get it. We Koch / Reason libertarians generally want to reduce spending, and $40 trillion sounds like a lot of money.

    However, we need to keep in mind our primary goal is always to increase immigration into the US. If plenty of people are crossing our borders now — even with a literal white nationalist as President — then imagine how much more immigration we could encourage with a Democratic President and free healthcare!

    #ImmigrationAboveAll
    #VoteDemocratForOpenBorders

    1. “$40 trillion sounds like a lot of money.”
      God, that’s breath-taking! Say what you want, OBL still has it, on occasion.

  7. And I get all my important dollar figures from Bernie Sanders so, case closed.

  8. I have no doubt that a government-run health care system could end up cheaper than what we have now — IFFFFFF
    — Nothing ever changed, so the bureaucrats could fine tune the living daylights out of every last expenditure
    — Those socialist bureaucrats were even more ruthless and heartless than the capitalist stereotype is among socialists
    — No innovation, no inventions, no better procedures, no changes in how people got sick

    Absent all that static crap, central planning just can’t keep up with free markets and people looking to make a buck by improving things. That’s what makes capitalism work.

    1. In the 1970s healthcare spending grew at 12% a year. In the 90s and 00s it grew at around 6% a year. Now it is growing at about 4% a year. It is almost like the laws of supply and demand solve these issues over time. Amazing.

        1. Your link seems to support John’s point: “Health spending growth has slowed”

    2. I have lots of doubts. In 2016 the government paid $1.6 billion to cover about 20% of the people. The private sector paid about $1.9 billion to cover the other 80%. Not sure how they are going to magically get better when we give them more patients. And keep in mind the government only pays out about 40% of what the private sector does, and still was more expensive.

      1. Something I think that is often not included is grant money. FQHCs would go out of business on just insurance reimbursements alone.

      2. Spiritus, those numbers are in the TRILLIONS, not billions.

  9. In addition to the monetary costs, there are important considerations in regards to choice. The decisions regarding what is and isn’t covered is already made by unaccountable bureaucrats can enforced through initiatives like “medical necessity”. Extending those restrictions to everybody can only result in rationing, which in this case means restricting people’s choices.

    When politically expedient decisions are made on questions like whether transgender patients should be entitled to sexual reassignment surgery regardless of their ability to pay, there will be other decisions that need to be made on how old you need to be before the expense of hip replacement surgery simply isn’t worth it anymore. After all, why should the taxpayer cover your ability to walk after 55, rather than use a wheelchair, when some 20 year olds have transgender issues to deal with for the rest of their lives?

    Even beyond the cost, the question to ask is whether we want these decisions made by politicians and unaccountable bureaucrats under the guise of Medicare for All or whether we’d rather make these choices for ourselves, using our individual qualitative criteria, which is what we’re free to do when we participate in markets.

    I don’t know what transgender 20 somethings are having for lunch today, but thanks to markets, I’m having a meatball sub. It’s a little expensive, but everybody who doesn’t approve of my qualitative choices and the cost I’m willing to pay can go fuck themselves. That’s what I want from the healthcare industry. I want to be the one who decides whether the benefit of getting hip surgery is worth it to me. Keeping the expense to taxpayers lower than it would be otherwise is icing on the cake.

    1. In addition to the costs of gender reassignment surgery you can be certain that every other quack remedy will also be required to be covered, from aromatherapy to witch doctors and shaman consultation, to faith healing and colloidal silver treatments. Every special interest will demand his congressman do something to get their pet treatment included (in exchange for generous campaign contributions of course).

  10. I think Sanders is being fairly honest here. He’s essentially showing his commitment to the cause by admitting that a comprehensive national health plan for the U.S. would consume a large part of the economy– and he’s right. Especially since most people who favor an NHS style system for the US believe that we’re just going to have the healthcare system we have now, you’ll go to your doctor and the government will cover the bill. Absent any massive restructuring of the healthcare system including doctors, nurses and other staff in regards to how they’re payed and even employed, the cost would probably drown us.

    But, if we truly nationalized the system, meaning we telling Dr. Livingston and Nurse Ratchett that they’re now a public employee on the GS payscale, the US economy could probably afford a national health system.

    1. payed = paid* jesus. Work and type at the same time.

    2. Diana….I have to tell you, I do not have a lot of faith in government (or Democrat candidate) projections. They invariably undershoot the cost – badly.

      1. Absolutely. But that’s not really the point I’m trying to make. Canada undershot its projections for their system– but they have one. England undershot theirs for the NHS, but they have one. However, their entire system is structured differently. I don’t see the people pushing for a national system here suggesting every hospital, clinic, doctor, nurse, and healthcare facility in general is going to be restructured (which includes closing many to control costs).

    3. Part of the problem is that doctors in the US get paid a LOT of money, 50% higher than the top GS grade at the low end. So nationalizing the entire industry would result in doctors having to take 50% to 90% pay cuts to fit on the GS scale. In a country that already has a low number of doctors per capita, it would make it much less desirable to become a doctor

      1. Part of the reason they get paid so well is because we prohibit perfectly decent foreign doctors from practicing medicine here. Then, on top of that, we cranked up the cost of education so a lot of these doctors graduate with $600k+ in student loan debt.

        We need more doctors and there are plenty from overseas that want to work here. We should let them.

    4. The important question: do you WANT to pay for VA-quality care for EVERYONE?

  11. Does national healthcare spending actually account for more that 20 percent of GDP?

      1. Thank you!

        1. The best part is that we are constantly told that the US spends far more than any other industrialized nation on healthcare as a percentage of GDP. And yet even Bernie’s rosy projections have us spending that same percentage.

      2. One thing I never see in these medical spending charts is how much of that is boob jobs, nose jobs, penis lengthening, calf implants, collagen injections, liposuction, lasik, etc.

        As compared to emergent and chronic spending, which should be broken down too if we want a complete picture.

        The US spends a lot on “health care” but I’ve been convinced that we spend a good chunk of that on vanity medial procedures.

        Elective vanity procedures should SURELY not be included in some taxpayer funded scheme, so it’s important to isolate those costs in discussion.

  12. $40 trillion for a government sponsored healthcare program?
    Hey, Comrade Bernie.
    Look up the word “credibility” in the dictionary.
    You’ll find you don’t have any.
    The only bigger idiot than Comrade Bernie are his supporters.

    1. I’m not defending Bernie’s plan, but total nominal health care spending in the USA was about $3.2 trillion in 2017 (the most current number I could find quickly) which of course was a combination of Medicare, Medicaid, employer provided coverage, the individual coverage segment, and private pay. With some inflation, our current system will probably spend close to $40 trillion in the next decade any way.

      1. Except the justification for a government takeover is that the government can do it cheaper.

        1. unless you’re an elected then it’s for the power.

  13. “Some hospitals, especially facilities that serve the rural poor, would almost certainly shut down or drastically reduce their services. ”

    This is a flawed comment. Everyone would be paid the same per procedure not per patient. It’s likely that the rural poor would have higher than normal amounts of patient visits.

    No, low volume hospitals would close, no matter where they are. A lot of small city hospitals would disappear, a lot of rural county hospitals would grow.

    1. This is unlikely. Paying per procedure incentivizes providers performing more procedures. We are headed towards outcome based measures, at least reverting back to a capitation model.

  14. I have a very pragmatic outlook: Does anyone really think that a candidate who tells the ~200MM people currently covered by private employer health insurance that they are going to lose it will win the 2020 election?

    Just think how the electorate reacted in 2010.

    1. Given how badly they fucked everything up with Obamacare, you might be able to sell it by promising them that you no longer have to mess with insurance and picking plans and struggling with copays or deductibles or out-of-network doctors if you tell them they can stroll into any ultra-modern healthcare facility within the 51 states and a top-notch doctor will fix your problems, gratis.

      1. Now tell them all the costs of this supposedly free healthcare will be front-loaded in the form of massive tax hikes on the middle class and see how many votes you still get

        But of course they won’t tell people that, and a good number of people wouldn’t believe it if they did

        1. When you tell them their taxes will go up, the popularity goes down.

        2. Tax hikes are like student loans. They’re down the road and we’ll drive off that bridge when we come to it.

      2. You have it backwards. People saw how screwed up Obamacare was and they won’t trust the “experts’” ability to construct single payer. Maybe it’ll work in about 30 years. But people today remember “If you like your doctor you can keep your doctor.” They won’t believe anything they’re told as to how a radically new system will work.

        1. I’m not sure if people do. You might be right, but I’m skeptical. But with the DNC saying that AOC (and the likes) “are the future of the party” someone somewhere thinks they have the momentum.

      3. That’s exactly how they are going to sell it. But the reality is that once it’s in place everyone has to go to the VA hospital for health care. You know, those places where you die after eight months on the waiting list for a colonoscopy. That’s the reality of government run healthcare.

  15. In an effort to move the party even further left, Elizabeth Warren will propose a $50 trillion health care plan during the next debate.

  16. Sanders tried to be a carpenter once and his carpenter partner said Bernie was the worst carpenter he’d ever seen. Yet here Sanders is, designing the health care system for the entire country. Chutzpah, I think is the term. Big Chutzpah.

    1. You know who else was a carpenter?

      1. Jesus Christ?

      2. Little Bill?

      3. Karen?

      4. Richard?

    2. To be fair, I hear Hayek was a pretty lousy carpenter too.

      1. To be fair, I’ll bet Sanders was a better carpenter than he is a politician.

    3. Yeah chutzpah.

      Not always a bad thing.

      I would not call him a schmuck.

  17. Yeah, but it’s not like I’ll be paying for that myself. So why should I give a shit?

  18. I wonder if the cost estimate takes all the costs into account.

    For example, if all medical care is free the demand will increase. Does the estimate include the cost of building more infrastructure? Training more doctors, nurses, technicians, etc.?

    And if becoming a doctor will no longer be a way to get a big paycheck, how will people be able to get all of the education and training to be a doctor? It’s not as if they’ll be able to pay off big student loans anymore. I suppose the taxpayers will have to pick up that cost too?

    1. “”It’s not as if they’ll be able to pay off big student loans anymore.”‘

      Free College

  19. “Bernie Sanders Thinks…”

    I’m sorry, but I’m going to need to see some evidence of this before going any further.

  20. This is an article that is playing “change the subject” to make people think there is a real argument here against single-payer. Look how the subject changes after this single paragraph: “There are several things worth keeping in mind about that claim. The first is that what they mean when they say single-payer would cost less is that total health care spending would be less overall; the cost to the government would be far, far higher than it is today, as all of the spending that now flows through private payers would move onto the government’s books.”
    And then the article goes on to speculate that prices will have to rise because hospitals and doctors will demand more money. But what is dishonest about this article and the arguments in the comments above is two-fold . 1–Bernie’s statement on the TV show continued “I don’t think there is a study out there that does not suggest that Medicare For All is far less expensive than the current system.” 2–“move onto the government’s books” is a favorite stalking horse of people who are not thinking critically. Since this is an article written by and for “free market” adherents, perhaps they would do well to remember that “move onto the government’s books” is exactly the same as “spending that flows through private payers.” It all comes out of the pockets of Americans. And finally, for those who are not aware of the facts, which seems to include the author of this piece, the current figure for national healthcare spending is 3.5 trillion annually. So over ten years, even if we can keep spending at current levels, we will have spent 35 trillion, exactly in the middle of what Bernie is proposing to spend on Medicare For All. He is not talking about spending an additional 3o-40 trillion. He is talking about taking the money that is now being wasted on things like three billing clerks per patient and five page paper bills from insurers and bloated insurance CEO salaries–taking that money away from the money-grubbing healthcare-industrial complex and using the clout of government to reduce the growth of healthcare spending from its current double the rate of inflation. If we don’t do that, as Bernie says, when ten years rolls around, we will have spent 50 trillion on healthcare, not the measly 35 trillion we are already for sure going to spend, with or without Medicare For All.
    Oh and by the way, when was the last time you used “price discovery” and enjoyed a “free market” when you went to the hospital? My guess??–NEVER HAPPENED.

    1. “using the clout of government to reduce the growth of healthcare spending from its current double the rate of inflation.”

      Somehow, this argument never seems to get made for education spending.

      1. If the efficiency is a given, just make the government offer a public option that you can buy into at cost. If it’s going to be so great everyone will sign up no?

        1. Because it won’t be offered at cost. You need to tie it to a constitutional amendment that prevents any subsidy from any other government account.

    2. “”He is talking about taking the money that is now being wasted on things like three billing clerks per patient “”

      There is no such thing as three billing clerks per patient. Period. It’s not even one billing clerk per three providers.

    3. So when your side said that this plan was better because it would save money, that was just a lie? We get to give up all choice in the healthcare market (including dental and vision) for…zero savings? What a deal.

    4. “Oh and by the way, when was the last time you used “price discovery” and enjoyed a “free market” when you went to the hospital? My guess??–NEVER HAPPENED.”

      Unfamiliar with medical procedures not covered by insurance, I see. You should look into it, you might learn something.

      1. If Cosmetic Surgery Has a Working Market, Why Can’t Medical Care?

        https://fee.org/articles/if-cosmetic-surgery-has-a-working-market-why-can-t-medical-care/

        1. Because cosmetic surgery is elective.

          Acute appendicitis is not.

          1. Doesn’t change the fact that plenty of medical care that’s necessary is also not so time-sensitive that there’s no opportunity for working markets.

          2. Neither is a flu shot. Or a knee replacement. Or a hearing aid. Or a hip replacement. And so on, and so on…

            1. Medicare does not cover hearing aids.

              Flu shots are inexpensive.

              Joint replacements are not totally covered by Medicare.

              1. The point is that many necessary or even desirable (flu shot) medical procedures are not overly time-sensitive. Spending 5 minutes on the net to see whether CVS or Walgreens is cheaper for my out-of-pocket flu shot is a good idea. Maybe you’ve been wanting to get knee replacement surgery for months or years, so waiting an extra day or two to research cost differences is a good idea.

                If you’re in an accident and need emergency treatment, then sure you don’t have time our inclination to seek out cost savings. But don’t ignore for a second that tons of healthcare costs are not, in fact, emergent or acute. Treatment for chronic conditions and elective procedures should be subject to market/cost pressures, since there is ample time to make rational cost-based decisions.

                1. Your decision about the hip replacement is also inelastic in many ways.

                  There may be a handful of surgeons in your area or insurance coverage who do a significant number of those. You have no idea about technical details of that. Therefore you must rely on expert advice to even decide on who will do this highly invasive surgery.

                  It has a high success rate overall.

                  It is not shopping for tires on the internet for price. Price is not what you are thinking at that point.

                  Some of those cosmetic things you can live without. When your knee, hip or shoulder are no longer functioning that is another matter.

                  Flu shots you are right but they are nothing in cost. Back in the day we had a department nurse with a pocket full of loaded doses. Roll up your sleeve. I would say my wife needs one because she is a teacher. She would hand me a syringe loaded up to take home. No big deal. I gave hundreds of them. It does not always work very well but all we had.

    5. “So over ten years, even if we can keep spending at current levels, we will have spent 35 trillion,”

      Keep spending at current levels? We provide free coverage for everyone, (including illegal aliens) expand the coverage to include free gender reassignment surgery and anything else lobbyists can get Congress to include, thereby vastly increasing the demand. We do nothing to increase the supply, and more likely reduce it, as doctors decide they don’t want a 50% pay cut. I wonder what will happen to the cost? Or the waiting list?

      Fast, Cheap, and High-quality: Pick two.

      1. It might be pick one.

    6. I spend less than $500 a year on healthcare, dipshit.
      I will kill you

      1. This is what needs to happen. Kick the progs out at the business end of a gun. They have no right to be here.

    7. Cnewhall
      July.17.2019 at 4:59 pm
      “This is an article that is playing “change the subject” to make people think there is a real argument here against single-payer.”

      This is the post of a fucking lefty ignoramus who hopes *THIS TIME* things will be different.

  21. ‘Bernie Sanders thinks…”

    He does?

  22. The rule is that any proposed government program always costs far more than it’s proponents claim that it will.

    The original Medicare cost projections in 1966 is that it would cost $12 billion by 1990. It actually cost $107 billion in 1990.

    You can bet that the cost estimates of those pushing “Medicare for all” are just as far off on their numbers – or even more so.

  23. Probably won’t cost that since that’s calculated on the current lavish levels of treatment Americans enjoy.

    No, just like every other nationalized system, the costs will be held down through rationing. Americans seem a little stupid on this point, which is actually the major point since it’s why the healthcare costs of other nations are much lower per capita than in America. It’s easy to do when you simply ration the expensive things and give cheap generics to everyone else or make them put up with their minor maladies.

    Where else they gonna go? Can’t afford insurance now since taxes are higher to pay for the public system. Can’t allow tax deductions for insurance since people will vote with their wallets.

    1. “‘No, just like every other nationalized system, the costs will be held down through rationing. Americans seem a little stupid on this point, “”

      Many are stupid on that point. They have no experience with nationalized health care. Many Americans are spoiled. They want the greatest of care and expect to pay nothing for it. They are willing to ignore the negative aspects of something then cry foul when negative comes to be.

      1. Having no experience with nationalized healthcare is not being spoiled, it’s being fortunate. You might as well contend the freedom of speech makes you spoiled because you’ve never had to suffer under state censorship.

  24. Who cares? So long as every grasping insurance bastard is put in the unemployment line, I’m fine with it. Also, just gut military spending and pay for that, and lots else.

    1. Look at the idiot over here.

    2. Spookk
      July.17.2019 at 6:23 pm
      “Who cares? So long as every grasping insurance bastard is put in the unemployment line, I’m fine with it.”
      Personally, as long as every scumbag comie gets fucked with a reusty chain saw, I’m fine with it.

      “Also, just gut military spending and pay for that, and lots else.”
      Cutting military spending to zero won’t cover existing social security costs, you fucking lefty ignoramus:
      https://www.bing.com/images/search?view=detailV2&id=77CB3F90BA12B93D516410D4827235C88AABDF27&thid=OIP.spAAyst4v8Y4W5FY2UQdQwHaFj&exph=960&expw=1280&q=Federal+Spending+Chart&selectedindex=0&vt=0&eim=1,2,6

  25. Again, who, what to believe? Figures don’t lie, but liars figure.

  26. We already spent $3.3trillion on healthcare as of 3 years ago and at the rate of our medical inflation that’s probably quite a bit more now. What happens to $3.3 when you multiply times 10? But you already knew that.

  27. For $40 trillion, I would expect to get a full cybernetic body that granted me speed and agility, a la a male version of Alita Battle Angel.

    For $50 trillion, I would want a real Lazarus pit straight out of Batman comics, so that—like R’as al Ghul—I could de-age and be pretty much immortal.

  28. what does healthcare look like under a single payer model where the healthcare providers are not government employees?

    Well, if you are curious, just go find a specialist who accepts medicaid. Go ahead, go out and find an orthopedist who is accepting new patients on medicaid. I’ll wait.

    Yeah, wasn’t that easy, was it? Try the same thing with the exchange plans. Yeah, they don’t take those either, do they?

    So head on over to the office that will take those folks. How does it work?

    Here in Broward county there was only one orthopedist you could go to with an exchange plan (at least for quite a while). Because they didn’t pay enough. I think the results were similar for medicaid (but most offices have a set-aside for a fixed percentage of patients).

    The one office that would take our exchange plan was a marvel of efficiency though. Because they were not getting paid enough, they were making it up in volume. They had a really big waiting room with chairs in rows. Not fancy with plants, but like a hotel conference room sales conference. Metal chairs in tight rows.

    The doctor and the X-ray techs literally ran from job to job. All day… running. On X-ray tech was running 4 rooms set up in a hub – so the aids could get the patients in and out while they were doing X-rays in another room. More efficient use of labor….

    It was like that everywhere. Mostly techs (not even nurses) doing all of the jobs. The doctor spent less than two minutes on most cases. He’d give an X-ray a quick look, ask a couple of questions and tell them what kind of cast to do. Next! Then he’d come back and inspect the results and post-cast X-ray.

    It was an amazing display of management and work ethic. And for orthopedics it actually seemed to work quite well. But I don’t think we’d like for our healthcare to be run this way in all cases.

    1. The doctor spent less than two minutes on most cases.

      Shit man, that’s how it feels on every insurance plan I’ve ever had through an employer too. The issue is the supply of doctors is very low.

      1. No…. I’ve been to regular doctors aplenty. This isn’t the normal quick visit without chitchat. I’m talking about most interactions happening while running from place to place. I guess you’d have to see it to understand the difference.

        They went from the folksy family doctor to a more formal office visit with minimal interaction over the period from 70’s to the aughts. The medicaid offices are a whole different animal. The fees they get are so low that they have to churn through 20 or more patients in an hour just to make a decent return.

        Of course, not every specialty is going to be amenable to this approach. Orthopedics is really good for this – because it is primarily reading X-rays and making a call (for office visits and followups… obviously they spend a lot of time in the operating room as well). But other specialties maybe not so much. You don’t really want your dermatologist rushing through that exam and missing an early melanoma.

  29. Why can’t the proponents of government health care not accept the fact that many people would still want to keep their private insurance plans. The UK has a ‘health service’ but everyone who choses and can afford to still pays for private health care.
    These socialists are determined to pull everyone down to the lowest possible level. This is envy at it’s worst. Just because everyone cannot afford to go private, then nobody must be allowed to go private.

    1. I know someone who will post an SJW post and end it with #allofusornoneofus. He doesn’t realize that the outcome of that would be none of us.

      1. That’s not entirely true. The children of congresscritters and other people connected with The Party would still get the best care available, with no wait.

  30. New Colorado VA hospital is state of the art, and more than $1 billion over budget. The project took 14 years. Under several presidents and VA secretaries, costs ballooned from $328 million to $1.73 billion as of its opening. Aug 17, 2018

    Only a tad bit over 5 TIMES the initial cost estimate just for a building. Actual medicine and care sold separately. I am sure this will come in right on budget like every other fiasco, I mean program. What could possibly go wrong?

    1. i was thinking the same thing. when has .gov ever succeeded in keeping costs in line?

      If the estimates are $40T, i would expect nothing short of $80T

  31. If you really are confused about why Dems keep pushing this plan even though the majority of voters are against it and the cost would bankrupt the country, all you need to is read Alinsky’s rules for radicals. #1 If you control the healthcare for the people, you control the people. In short, control who lives or dies and you cannot be stop when you decide to suspend individual freedoms and seize power only for the State and ruling class.

  32. Blah blah blah- something every other country has figured out but the USA can’t.

    Greatest country in the world couldn’t solve its way out of a paper bag.

  33. […] “Medicare for all” would bankrupt the country. This piece explains lays out the troubling details. […]

  34. $20 or $30 or $50 trillion over 10 years?…what comes after 10 years, 20 years, 30 years? Are we gonna be spending $500 trillion over the next century? I doubt the government’s antiquated Cobol computer systems candle such big numbers. The absolute best and cheapest form of healthcare you can buy is good health…get it and keep it. Avoid mainstream medicine at all costs or use it only in an emergency, otherwise as you age you are going to pay the piper.

  35. […] much would “Medicare for All” cost? Up to $40 trillion over ten years after implementation, estimates Bernie Sanders, its truest believer. That number has […]

  36. […] much would “Medicare for All” cost? Up to $40 trillion over ten years after implementation, estimates Bernie Sanders, its truest believer. That number has […]

  37. […] much would “Medicare for All” cost? Up to $40 trillion over ten years after implementation, estimates Bernie Sanders, its truest believer. That number has […]

  38. Please remember, Medicare today is *NOT* free and “Medicare for All” should not be either. While working, you pay via paycheck withholding. Just like corporate healthcare is today. When you retire, you pay for Medicare part B (Doctor’s visits), D (Perscription drugs) , and either C (Medicare Advantage) or Medigap policy from a commercial insurance company.

    If you are low income or no income, you will receive a “Medicaid” type coverage for free or for a subsidized rate.

    If you really want “Single Payer” insurance, do you really want the US Govt to try to process 300+ Million claims? We all should remember just how well CMS (Medicare) did with the Govt. sponsored exchanges! A much better solution would be to have the major insurance companies process the claims by region to distribute hte load across multiple providers and have them agreed to back each other up to cover peak loads or natural disasters.

    Study the German Healthcare system to understand how a model similar to this works in real life. Get real, Universal Healthcare is never going to be free. You can either pay fees at set rates or pay more in taxes. Again, do you really want the Govt. to be the sole arbitrator of all health insurance coverage rules? Really?

  39. […] taxes” will certainly be needed to cover the plan’s cost—between $30 trillion and $40 trillion over ten years, according to estimates Sanders released last […]

  40. […] saying, “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the […]

  41. […] saying, “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the […]

  42. […] further, saying, “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the […]

  43. […] “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow […]

  44. […] “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow […]

  45. […] “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow […]

  46. […] further, saying, “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the […]

  47. […] further, saying, “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the […]

  48. […] further, saying, “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the […]

  49. […] further, saying, “Under our plan, people go to any doctor they want.” He admits it will cost between $3 trillion and $4 trillion per year, about what the government now spends on everything. How will he pay for that? Well, somehow the […]

  50. […] admitted his Medicare For All alone will cost up to $40 trillion dollars and he will tax the middle class. […]

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