Medicare for All

Why the Failure of Vermont's Single-Payer Plan Is the Best Argument Against Medicare for All

An argument against Bernie Sanders' health care plan in The New York Times.


In today's New York Times, I look at the failure of Vermont's single-payer health care plan, which collapsed due to low public support and estimates projecting high costs and large tax increases.

The Vermont experiment presages many of the political and policy challenges that would arise under any attempt to pass Medicare for All, the single-payer plan proposed by Sen. Bernie Sanders (I–Vt.) and backed by Sen. Elizabeth Warren (D–Mass.). As I note at the end of the piece, the national political environment for Medicare for All would, if anything, be even less favorable than the political and economic environment for single-payer was in Vermont:

The Vermont plan was done in by high taxes, distrust of government and lack of political support. Any effort by a Sanders administration to enact a single-payer system at a national level would probably be doomed by similar problems.

Like [former Vermont Governor Peter] Shumlin, Mr. Sanders is a devout single-payer supporter who has campaigned aggressively on the idea. And like Mr. Shumlin, Mr. Sanders has so far declined to lay out a plan for fully financing his Medicare for All system.

But while some polls show majority public support for single-payer, that support declines substantially when faced with trade-offs like the elimination of most private coverage or higher taxes—two components of Mr. Sanders's plan.

Similarly, Medicare for All supporters argue that single-payer would reduce the nation's overall health spending. But savings are heavily predicated on the assumption that the new government-run system could pay Medicare rates, which are typically lower than those of private insurance, to providers across the board.

Legislators in Washington State started with the same assumption when they attempted to design a state-managed insurance plan, and it proved wrong. The plan passed only once rates were increased. Yet even a plan with lower rates would still represent an enormous increase in total government spending.

Backers of Medicare for All, including Sanders himself, often argue that the U.S., which spends a greater percentage of its economy on health care than other countries, should be able to finance a universal system. If other countries can do it, why not America?

One problem with this argument is that the plan Sanders has proposed is far more generous than the systems in other countries, eliminating co-pays and most out of pocket spending while covering a broader array of services than you find in other developed nations. It's also more generous than most employer-sponsored plans, and even more generous than our current seniors-only Medicare system, a big component of which is heading for insolvency in less than eight years.

In short, passing and implementing a functional Medicare for All plan along the lines that Sanders envisions would be extremely difficult under any imaginable circumstance. And if it couldn't work in a relatively politically hospitable environment like Vermont, it's hard to see how it could work at a much larger scale.

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  1. Single Payer Medicare For All is such a colossal clusterfuck that only the two craziest Democrats running for POTUS support it (Warren and Sanders).

    1. You need to get over your issues with Warren. She now has a solid chance of being the nominee.

        1. As a left-libertarian, I believe the US owes tens of trillions in reparations for slavery. So 1.5 trillion for environmental racism is a good start.


          1. There’s no such thing as a “left-libertarian,” particularly not one who would espouse so-called “reparations for slavery,” whatever those are.

          2. You, like most lefties have no concept of how much money actually exists to spend. Plus reparations for past deeds is ridiculous since slaves were around in all races throughout history and we cannot pay the slaves because they are gone and we have spend untold billions on social benefits on minorities in the US so they have already been paid.

        2. I hope this includes tearing down the various dams and water projects that divert the Colorado River over the Continental Divide to Denver.

        3. “the concept that climate change disproportionately affects minority communities.”

          Lol, nice try. Unlike the upper class twits who are your voting base, minorities are largely regular people who don’t want to vote for a shrill cat lady. Sorry!

    2. Stick to child porn trivia dumbfuck. Only biden doesnt support it.

  2. Step 1: Remove tax preference for employer plans.
    Step 2: Give everyone Health Savings Accounts
    Step 3: Provide subsidies to those accounts for the truly needy
    Step 4: Set a Pre-existing condition date for people with new coverage- insurance companies don’t need to pay for pre-existing conditions for the first year of coverage.
    Step 5: …
    Step 6: Profit!

    It isn’t libertarian, but it is a shit ton better, and simpler than what 99% of the rest of the field is offering. And it makes people actually pay attention to what they are buying in healthcare, instead of the current all you can eat buffet that exists for most of the public.

    1. slight adjustment:
      Step 1: transfer the tax preference from employer plans to individual/family plans

      1. Yes, that is a better description of what I meant. Thanks.

      2. This should be done no matter what. Its unbelievable that that stupid thing from the Great Depression is still hanging around our necks.

      3. No – you have to eliminate the tax subsidy entirely. The tax subsidy is a big reason why prices go up. It distorts the market – and providers know that. And in particular it distorts the market at the lower end where the tax subsidies become insignificant. Same phenomenon applies re housing prices.

        That said – none of this (nor Medicare-for-All) is actually fixing what’s broke with our healthcare system. The problem in the US is not a financing problem.

  3. All government has to do is repeal the law of supply and demand, and then they can make health care free for everyone.

    1. Just ban being sick or injured and no one will need healthcare

      1. Or, go back to the system we had 60 years ago where you could pay for most procedures out of pocket.

        1. It was merely 30 years ago when I had catastrophic coverage for only $5 a month.

          1. Overall, costs have been going up about 8% a year since the early 80s. That’s an unsustainable exponential function.

            Until people actually get serious about determining the actual cost of healthcare, as opposed to how to pay for it, things are going to continue to be fucked up. If a CT scan costs $1000-2000 here, we need to figure out why that is when the Japanese pay about 10% of that. (Subsidies? The US acting as the “line of first cost” for the rest of the world? Something else? Regardless of the payment mechanism, what’s the no-bullshit, real cost–is it actually $500, for example?)

      2. Woah, let’s not toss the word “ban” around, people don’t like that. What we need are some common sense sickness reforms. I propose a 10 day waiting period between when you want to get sick and when you’ll be allowed to get sick, that should give the system adequate time to prepare to deal with you.

  4. No coverage of the fact that half a million people in CA currently have no power, with another 300k of us scheduled to lose it later today, because our local state-backed power monopoly can’t be bothered to maintain its infrastructure?

    1. Suing them into bankruptcy didn’t help much.

      1. Well, we just need to try again, then!

      2. You can’t bankrupt a legally mandated monopoly. The state will just bail them out.

        I saw toss the monopoly into the woodchipper and let SCE come into northern California. No fucking way could they do any worse. Give me a choice of providers.

    2. I’m not sure who to blame more, California government or the power company. Ultimately government created them, so I tend to blame them more but it’s obvious PG&E are far from blameless. It’s the typical tale of public private partnership malfeasance.

      I often wonder what it will take to break the Democrats one party rule there, or even just for the people to realize that state monopolies are the worst kind. I would have thought rolling brown outs would have done the trick, but it seems even a return to 3rd world conditions doesn’t move the needle. All the rage I’ve seen is directed at PG&E, with the anger towards government being of the ‘why didn’t you monopoly harder’ variety.

      Tragic. And I wager the government will double down on crippling PG&E and/or create a new entity that fucks things up even worse, as if they aren’t the central problem.

    3. A state-backed power monopoly that went bankrupt, by the way.

      The reason for the fiasco is because PGE got sued for the last big fire because wind knocked down a power line or something. So now the policy is to shut off power if it looks like wind. Fucking nuts.

      And then they warn that it might be up to five days to get the power restored. Power that was cut by flipping a switch. WTF? It takes five days to reboot?

      Fix your damned infrastructure!

  5. Obviously the goal of Koch / Reason libertarianism is to increase the wealth of the 10 richest people on the planet. So I’m sympathetic to the argument that single payer would be bad because Charles Koch’s taxes would go up.

    However, another important goal is unlimited, unrestricted immigration into the United States. We must, therefore, consider the possibility that free health care would make this country a more attractive destination for immigrants. I could be persuaded to support Medicare for All if a Cato study showed it would dramatically increase immigration across our border with Mexico.


  6. OT: Braves to reduce chop in today’s NL playoff game:

    1. That worked well.

    2. Just wait until baseball fans start chanting “Free Hong Kong” instead

  7. Medicare-for-all will work.
    It will bankrupt America in no time at all.
    That’s what Comrade Bernie and his band of merry morons want.

  8. Any effort by a Sanders administration to enact a single-payer system at a national level would probably be doomed by similar problems.
    Unfortunately, not true. Enactment of such a plan is a distinct possibility. It will never work, but that may not keep it from being passed and signed.
    See: Affordable Care Act.

    1. LarryA,
      If Sanders (getting less likely) or one of the democrat candidates becomes president there is strong possibility that it could be enacted and with the same results. The difference between the state medicare type health care for all and the federal one is the state goes broke the federal government (national taxpayers) would be there to pick up the pieces while on the national lever the federal government would just enact more taxes on the taxpayers. Also there would be private health insurers to help to pick up the pieces but at the national level there would not be any more private insurance companies.

    2. In most cases the voters in this country have different parties in government controlling the 3 branches of government so it will most likely be difficult if not impossible to pass a national health care bill.

  9. If Sanders and company are so worried about people being bankrupted from medical bills then why do they never propose a plan that covers major and catastrophic costs rather than plans that will cover *everything*.

    This stuff would be more viable if it were a final backstop that covered, say, costs after the first 20,000 a yr / quarter-million for lifetime.

    In such a situation you still have incentives for individuals to conserve healthcare, competition has room to keep costs down, a niche for private insurance to fill, while providing a real ‘social safety net’.

    1. Your idea makes too much sense. What planet are you from? Are you here to serve man?

  10. The difference between private health insurance and government health care is if the private health insurance screws you you can go to another company but when the government health care screws you there is no other place to go and your taxes will be increased to correct the screwing they just gave you so you get screwed twice.

    1. Dry.

    2. Single payer health insurance is just the stepping stone to government operated health care where doctors’ orders literally become orders backed by legal consequences for disputing them or engaging in any behavior that might increase health care costs. Goodbye snow skiing.

      Once the health providers only have a single source of income, it is trivial to put them in bankruptcy and replace them with government operated health facilities.

  11. The only unquestionable thing about the plan Bernie fraudulently calls “medicare for all” is that it eliminates medicare completely, and steals the trust fund.

    1. There is no trust fund.

      1. It is sitting in a file cabinet in West Virginia. Deal with it.

        1. A vault in Appalachia?

  12. So why does it work in other countries?

    1. Who says it works? You swap out high prices for long waits and lower quality.

      1. And don’t forget the great health care in other countries don’t pay the real cost of research and development of new drugs and treatments. So what do we want? Do we want to constantly improve the ability to treat and cure disease or not?

    2. Where it works is in countries that still have a private system for those who pay for it. Places where private systems has been outlawed DON’T have a system that works. Places where you literally have a board meeting to see who gets treatment and who does not. Places with month or year long waiting lists for necessary procedures. Places where nothing is covered. Places that have 60% taxation rates. Places where people don’t go to the doctor UNTIL they get sick. Places with highly homogeneous populations.

      These places do not all have the same plan. They’re quite varied. France is very different from Germany which is very different from England, which is very different from Denmark, etc. Which are all massively different from various Asian plans.

  13. The VA is the best argument against Medicare for All. We already know how poorly the government runs healthcare.

    1. Right. And especially if you consider that the VA is how they treat a bunch of trained killers. How do you think they will deal with the civilians?

  14. You don’t understand, Congress can do whatever the fuck they want. They’ll pass a Medicare For All bill, and if they can’t pass a tax bill to fund it, then no one gets health care. If they do pass a tax bill but can’t raise the funds, then we get a shitty ass system. If they manage to raise enough to fund it, then we still get a shitty ass system and everyone is driven into poverty. Success!

    And then the Republicans will campaign on getting rid of it, and when they get control of the house, senate, and presidency, they still won’t be able to rescind and replace it because they never bothered to work up a plan.

    A pox on the taint of both houses.

    1. I don’t see a Medicare for all passing at all because I believe the American voter will again split the congress and Presidency into warring factions and prevent this catastrophe from happening. People already suffered with huge personal costs in co pays and deductibles from Obamacare.

      1. Universal health care was passed in NY’s lower house years ago. The Senate, even the now democrat controlled Senate will not pick it back up because the price tag is equal to the entire NYS budget.
        They know they can’t double their tax revenue. NYS it pretty much taxed out.

        NYS was short 50 million in revenue due to millionaires leaving. Cuomo said the issue was as serious as a heart attack in a news conference.

  15. The real crux of the issue of providing insurance is charging the owner(s) enough in premiums to pay for those who use the system a lot, or cannot pay, and/or otherwise abuse the benefits. You simply need a far greater number of non-users or casual users to cover the costs of the 10-20% who use it the most. It’s the old 80-20 proposition (Pareto principle) where 80% of the premiums pay for 20% of the users and the other 20% of premiums cover the majority 80% who use the service sparingly overall. No matter how government tries to equalize the coverage, the majority will always pay for the minority to use the benefits. Th promises of providing something for nothing are no more than farts in a windstorm. And politicians are experts at creating mindless brain farts.

  16. Medicare for All is feasible. You just have to get doctors to accept a wage of $15 an hour.

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