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Bernie Sanders’ New Single Payer Plan Is a Wild Legislative Fantasy

The new plan refuses to grapple with costs or tradeoffs.

Rodger Mallison/TNS/NewscomRodger Mallison/TNS/NewscomToday, Bernie Sanders will release a proposal for single-payer health care, co-sponsored by 15 Democrats. To call it a plan is, in some sense, too generous: Although it envisions a sweeping and generous system that would make government the primary payer for nearly all health care in the United States and virtually wipe out employer health coverage in the space of just a few years, it is not really a plan. Instead, it is a legislative fantasy built on a combination of wild overconfidence in government and an almost comical refusal to grapple with costs or trade-offs.

To be sure, it is a compelling fantasy: As outlined in a New York Times op-ed, it would offer coverage to all and benefits more generous than most employer provided plans, with no copayments. It would break the link between insurance coverage and employment and put an end to Obamacare's unstable system of exchanges and subsidies. Although it would allow some private coverage options to exist at the margins, it would mean that most Americans never have to deal with an insurance company again. More than anything else, what Sanders is selling is simplicity, ease of access, and systematic unity.

"I think the American people are sick and tired of filling out forms," Sanders told The Washington Post. "Your income went up — you can't get this. Your income went down — you can't get that. You've got to argue with insurance companies about what you thought you were getting. Doctors are spending an enormous amount of time arguing with insurers."

This is by far the most effective part of the Sanders pitch: America's health care system is a fragmented, confusing, and unequal mess, split between employer coverage favored by the tax code, individual private insurance partly subsidized by Obamacare's tax credits, and government payers like Medicare and Medicaid. Even when interacting with private payers, it is often maddeningly difficult and bureaucratic. On top of that, it is also incredibly expensive.

But this frustrating, pricey, and unnecessarily complex system is a direct response to decades of flawed and contradictory government policies. Most working age people get their health coverage through their job because of a tax carve out for employer benefits that dates back to World War II. Medical prices, to the extent they exist at all, are opaque in part because of an overreliance on generous insurance that stems from this tax code favoritism and in part because of the byzantine price setting mechanisms employed by government payers, which, in turn, exert influence on the rates that private insurers are willing to pay. Premiums are rising in the individual markets created under Obamacare in large part because of regulations like guaranteed issue and community rating that are built into this system.

The fragmentation and frustration that Sanders decries, in other words, was created by government. Yet his solution is to wipe it all away and replace it with a system that relies on vastly more government, at huge probable expense.

Sanders argues that this would allow the government to offer comprehensive coverage while reducing health care spending and saving most families thousands of dollars a year. Turning over nearly complete control to the government would not, on its own, reduce national health care spending. Health insurance industry profit margins are modest, and eliminating them would barely make a dent in overall health care spending. In some ways, government payers like Medicare, which tend to be lax when it comes to fraud prevention and wasteful spending, are actually less efficient than private insurance.

As the primary payer, government could, of course, exert far more influence on reimbursement rates for health care services. But that amounts to a plan to pay doctors and other health care providers less. Medicare typically pays far less than private insurance for most services, and Medicaid pays less still. But the health care sector as we know it today could not exist if Medicare payments were extended to all services. Cutting all reimbursements to Medicare levels would mean that many health care providers would quit or shrink their operations. Hospitals, many of which already struggle to maintain their huge and expensive payrolls, would reduce service or close their doors entirely.

The likely outcome of such a transition would be massive, sustained chaos across the health care sector. Even if the chaos were somehow manageable, the easy access that Sanders promises would be swiftly undermined by service disruptions and other complications stemming from the changeover. In making his case, Sanders tends to ignore all of this. His plan exists in an imaginary world without economic tradeoffs or consequences.

Nowhere is this more obvious than in its promise of benefits. Sanders frequently argues that his preferred system would merely put the United States in line with other developed nations. On the contrary, it would go far beyond what other countries with single payer systems offer. The Sanders plan would offer a far greater array of benefits than Australia, the Netherlands, or Canada—a country that Sanders often uses as a comparison with the U.S., but where the majority of the population relies on supplementary private insurance to cover the gaps left by the government system. Many international single-payer systems also require some form of copayment from the individual seeking service; the Sanders plan would make all of its benefits available without any individual contribution.

Instead, it would be paid for entirely through tax increases. Which tax increases would those be? On who, and for how much? On these questions, the Sanders plan is silent.

This is the real tell in Sanders' pitch. Although it is willing to imagine long lists of benefits in great detail, but it has essentially nothing to say about how to pay for them. It is a fantastical sales pitch for a luxury product with no price tag attached.

Single payer has never had a chance in the United States precisely because the tax increases required to fund it has proven too high for even liberal constituencies. Sanders' home state of Vermont, one of the most liberal states in the country, nixed a single payer plan for this reason. Sanders' refusal to describe a funding mechanism makes clear that he has not discovered a way around this problem. His only tactic is to avoid talking about it in any detail.

The American health care system has many problems. But the Sanders plan would not solve any of them. It is not really a solution in the conventional sense at all. It is a vision of an impossible world in which those problems simply don't exist to begin with.

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  • Rich||

    Bernie Sanders' New Single Payer Plan Is a Wild Legislative Fantasy

    Hey! It'll pay for itself!

    "I think the American people are sick and tired of filling out forms," Sanders told The Washington Post.

    "Sick and tired"? That's covered by the plan. Just fill out this form.

  • Adam330||

    Says the guy who loves the income tax, which is the most complicated set of forms known to man.

  • loveconstitution1789||

    Bernie is right. People are sick of filing out forms.

    Cash for most medical services and catastrophic health insurance for major stuff. Then the government could cut all social programs too to let people have more of the money they earned to pay for said medical services in cash.

  • What about Sloopy's mom?||

    Cash for most medical services and catastrophic health insurance for major stuff.

    This is an interesting article on the subject:

    When it comes to America's spiraling health care costs, the country's problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country's medical spending.

    Of course, health care has its own 1% crisis. In 2009, the top 1% of patients accounted for 21.8% of expenditures.

    [...]

    The top 5% of spenders paid an annual average of $35,829 in doctors' bills. By comparison, the bottom half paid an average $232 and made up about 3% of total costs.
  • Last of the Shitlords||

    Bernie should be living in a piss soaked NYC alley, screaming his inane ideas at a garbage can.

  • TrickyVic (old school)||

    ""Bernie should be living in a piss soaked NYC alley, screaming his inane ideas at a garbage can.""

    Or from inside a garbage can. We'll just call him Oscar from that point on.

  • Migrant||

    The tax payer funded UK system is cheaper, safer and more successful by far than the dysfunctional mess in the USA. Nobody is ever refused treatment due to lack of money or insurance cover. It is you who is living in the piss soaked alley.

  • Longtobefree||

    Right -o
    They are refused treatment regardless of income (politicians excepted).
    If they can manage to live long enough to keep the appointment months down the road, they get the same indifferent union dictated coverage as all the rest.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Robbzilla||

    He would be, if he hadn't been elected.

  • jerryg1018||

    I'm 75 and never had to fill out a medical claim form for any treatment. I've been covered by CMS/Blue Cross, employer insurance, the military and Medicare. The physician's offices always fill out the claim forms, I never see them.

  • IceTrey||

    It's absolutely incomprehensible to me why people are asking for LESS freedom in the healthcare market.

  • sarcasmic||

    mumble mumble trade freedom for security mumble mumble

  • Mickey Rat||

    The perception of security at any rate.

  • Don't look at me.||

    Not sure we are asking, but it sure is getting pushed. Why would that be?

  • Zeb||

    Well, we aren't asking. But a lot of people are.

  • Earth Skeptic||

    MORE FREE STUFF!!!

  • Brandybuck||

    We aren't asking. Bernie is telling.

  • C. S. P. Schofield||

    Because people don't see what they already have as 'freedom' to any real degree. And, frankly, they have a certain amount of sweet reason on their side. What with the restrictions on the insurance market, people usually have very few realistic options when it come to health insurance, which they have been conditioned to believe (not without reason) is necessary to obtain health care. So, having restricted peoples' options to the point that they don't feel they have any choices, the Statists now propose to restrict them further. It's really quite clever, when you think about it.

    *spit*

    If I thought it had the chance of a fiddler's bitch of actually working, I wouldn't be that upset. But it won't. It will further distort the health care market, and then drive it to failure, right about the time MY health starts to go from old age.

    Progressives, Guillotine, some disassembly required.

  • Tony||

    It's similarly baffling why you guys think paying more for shittier healthcare is synonymous with freedom just because it's a insurance company raping you up the ass instead of the government.

  • Citizen X - #6||

    You sure raped that strawman in the ass, as is your wont.

  • fish||

    It's okay….they switch positions afterwards and t o n y takes it "Ear of Corn" style.

  • Adam330||

    No one here thinks the current system is wonderful. That doesn't mean we have to support the shitty system that you prefer.

  • Get To Da Chippah||

    THOSE ARE THE ONLY POSSIBLE CHOICES, SHITLORD!

  • BYODB||

    Burn that strawman!

  • MarkLastname||

    You actually believe the government has made health insurance cheaper? You're just too precious.

  • Unlabelable MJGreen||

    you guys think paying more for shittier healthcare is synonymous with freedom

    You're the only one who thinks that, as demonstrated any time we propose reforms to increase freedom in the buying and selling of medical services.

  • Red Rocks White Privilege||

    Ever notice that Tony and the single-payer supporters start sputtering whenever the idea of price transparency is brought up? We have the most opaque system in the world because people got used to the idea of using public and private insurance as a pot of free money to pay for healthcare.

    It's not really an accident that healthcare spending began an exponential climb beginning in the 1960s after Medicare and Medicaid were passed.

  • Robbzilla||

    If you ever want an exercise in frustration, ask your provider how much a procedure costs.

  • Enjoy Every Sandwich||

    I just got out of my company's benefit briefing for the new year. Boy, premiums and deductibles just keep going up. I seem to remember that the government had a plan for that...whatever happened to that?

    But even with my costs going up I still at least get good care from the doctors of my choosing. That's better than the VA-style shitshow that you and Bernie would like to impose.

  • CE||

    Because the government is mandating what coverage the insurers must provide, and not allowing them to offer real insurance.

  • Last of the Shitlords||

    Tony you worthless twat, Obamacare IS what made healthcare shittier. In what inane fantasy of yours has healthcare actually improved over the last few years?

  • Red Rocks White Privilege||

    In what inane fantasy of yours has healthcare actually improved over the last few years?

    More people got put on Medicaid. It didn't stop the costs from going down, but by god, we sure did make more people dependent on government welfare!

  • C. S. P. Schofield||

    If the choice is shittier healthcare under government supervision, or shitier healthcare provided by the market, I will go,with the market. Governments do not react quickly enough to deal with changes in the real world, and yet do not go bankrupt nearly soon enough when they fail to do so. The history of single payer healthcare is dismal, whereas the history of healthcare provided by n even somewhat fremmarket is much better.

    Governments are good at bean counting and brute force. Neither aptitude seems well suited for dealing witth healthcare.

  • Migrant||

    The tax payer funded UK system is cheaper, safer and more successful by far than the dysfunctional mess in the USA. Nobody is ever refused treatment due to lack of money or insurance cover. The marketisation of health is a disaster for millions and a source of profit for few.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Migrant||

    Because you are only 'free' to pay large amounts of money for a dysfunctional mess. We in the UK still have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Americans and no fear of medical bills. Our system is cheaper, more efficient and better than the crazy US health market which is distorted and crippled by cynical profit makers.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Will Nonya||

    rinse and repeat eh.

    He does have one point "US health market which is distorted and crippled by cynical profit makers" just no clue as to why that is, how to fix it or how his socialist system contributes to it.

  • Fist of Etiquette||

    It all sounds very rational.

  • albo||

    Health care as friendly as the IRS and as efficient as the Pentagon's purchasing process.

  • Citizen X - #6||

    I, for one, can't wait until going to the doctor's is exactly like going to the DMV. Right down to the quality of the medical care available.

  • CE||

    We already have a working example of government run health care. Its the VA.

  • Citizen X - #6||

    "Working" might be a bit generous.

    A friend of mine from college briefly worked as a surgeon for the VA. He said that he was idle most of the time and it was boring as hell, because his prospective patients kept dying before they ever got approved for surgery.

  • loveconstitution1789||

    The VA is not that bad for most of us vets but I would warn anyone thinking the VA health system is better than free market health care. It is not.

    The VA cannot even print out an invoice for 5 years worth of billing records to see what I should have been billed and what I paid. They can be so incompetent that they said I owed $59 and then sent me a US treasury check for $59 then said that I needed to pay it back.

  • Red Rocks White Privilege||

    The VA is not that bad for most of us vets but I would warn anyone thinking the VA health system is better than free market health care. It is not.

    My anecdotal experience based on people I've known is that the smaller institutions seem to be run far more competently than the big-city VAs. Probably has something to do with the scale of operations and staffing required to run such large hospitals.

    I'd be willing to bet that de-centralizing the big hospitals and setting up smaller branch VAs throughout larger urban areas would dramatically improve care and administrative quality at these places.

  • swampwiz||

    I have had plenty of private firms treat me with that same level of incompetence (cough, AT&T, cough).

  • ThomasD||

    The VA is a paragon of efficiency and clinical excellence compared to the Indian Health Service.

  • C. S. P. Schofield||

    And overseen by Congress, which oversight is one of the major reasons the Pentagon purchasing process is so damn bad.

  • Earth Skeptic||

    Or, health care as satisfying and effective as public education. That is the largest government-run consumer service agency in the US, with all the "providers" government employees.

    Now I happen to think some/most teachers are truly dedicated and relatively effective (married to one). But most people, especially progessives, like to harp on systemic failures, e.g. urban school systems.

    Can't wait to see health care delivered the same way.

  • Uncle Jay||

    You're right.
    What could possibly go wrong?

  • Migrant||

    The tax payer funded UK system is cheaper, safer and more successful by far than the dysfunctional mess in the USA. Nobody is ever refused treatment due to lack of money or insurance cover.

  • sarcasmic||

    In my opinion the biggest driver of health care costs is payroll. Medical professionals are paid ridiculous amounts of money, and that is a direct result of the third party payer system. But I don't see that changing anytime soon. Maybe it would change if medical services were priced, and people could shop around for non-emergency care. Insert some competition and prices might reflect actual value instead of being inflated by decades of the third party payer system.

    One can dream.

  • albo||

    Medical professionals are paid ridiculous amounts of money,

    Because they've earned it and have enormous costs to do business and loans to pay back

  • sarcasmic||

    I don't care what they think they deserve, and their loans are not my problem.

  • albo||

    So, you change the whole social contract--spend years and thousands of dollars becoming a doctor because you'll be awarded for your labor and able to pay your loans back under the current medical market--and basically tell doctors to suck it?

  • ||

    So, you change the whole social contract--spend years and thousands of dollars becoming a doctor because you'll be awarded for your labor and able to pay your loans back under the current medical market--and basically tell doctors to suck it?

    Yup.

    It has to happen sometime. No use pretending it doesn't.

  • Zeb||

    As with so many parts of the economy that government meddling has fucked up, making it less fucked up will cause some pain for some people. But putting it off only makes it worse in the end. Basically comes down to "you fucked up, you trusted us".

  • Mickey Rat||

    Part of that pain is going to be less people willing to go through the training necessary to be an expert medical professional. The result is fewer doctors or lowering the standards. There are lot of aspects of being a physician that make it an unattractive profession without high compensation.

  • ||

    There are lot of aspects of being a physician that make it an unattractive profession without high compensation.

    Yet, somehow, I think that an existing need for doctors will manage to find a price that will make doctors available.

  • albo||

    It has to happen sometime. No use pretending it doesn't.

    Single payer? It doesn't have to "happen sometime," one, and if you pull this off, the country's going to have a lot fewer doctors.

  • ||

    No, not Single Payer. Reducing the restrictions on the market for medical services so that costs go down across the board, thus eliminating the need for pie-in-sky fantasies like Single Payer.

    "I expected to make a mint off of this artificially restricted market, and organized my life around that plan" is not a reason to preserve artificial restrictions on a market.

  • TO in TX||

    Bravo. Explanations like this should not be necessary, but are needed to preemptively counter the expected arguments against.

  • BYODB||

    If you deregulate the market and crack open the AMA salaries would likely go down as more new Doctor's are created but pretending that Doctor salaries are the problem is a lie.

    Doctor's are well paid, but don't pretend it's unrelated to the jobs they do of making sure you don't die. Oh, and if you can prove they are actually human and made a mistake you can sue them out of the industry where they will be almost immediately crushed by triple-digit student loans. The average student loan debt for a graduating doctor is $175,000. Also, the very tip-top of Doctor's are Surgeon's not M.D.'s for pretty obvious reasons.

    But no, lets appeal to envy. It works so well!

  • ||

    Doctor's are well paid, but don't pretend it's unrelated to the jobs they do of making sure you don't die.

    I won't if you don't pretend that their current inflated wages have been set by a free market.

  • BYODB||


    I won't if you don't pretend that their current inflated wages have been set by a free market.


    Agreed! I suspect that in any system, Surgeon's will be one of the most highly paid occupations in the country though.

  • NotAnotherSkippy||

    You're the one with the pretence that doctor salaries are the primary driver. Swiss salaries aren't much different from the US and yet they pay about a third less for medical care than we do.

    Envy is a nasty shade for anyone. Competition in the market? Sure. Don't be surprised when most salaries don't change much. Although I don't have much heartburn over orthopods facing competition from mexican carpenters. The skill sets are about the same.

  • Migrant||

    The tax payer funded UK system is cheaper, safer and more successful by far than the dysfunctional mess in the USA. Nobody is ever refused treatment due to lack of money or insurance cover

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Jujucat||

    Ever hear of incentive by chance?

  • Earth Skeptic||

    So, more dumber doctors?

  • $park¥ leftist poser||

    So, you change the whole social contract

    *facepalm*

    spend years and thousands of dollars becoming a doctor because you'll be awarded for your labor and able to pay your loans back under the current medical market

    I don't know about you, but I'd rather have a doctor that wants to be a doctor and not a doctor that just wants a pile of money. I have no problem with people wanting a pile of money, but I want a doctor that has an interest in my well-being and not just how much money I'll hand him.

    And if that makes doctors unhappy, then yeah, they can suck it.

  • Crusty Juggler - Lawbertarian||

    they can suck it.

    What's it?

  • $park¥ leftist poser||

    A black cherry lollipop.

  • Jujucat||

    A booby.

  • Johnny B||

    Here in the socialist paradise we call "Canada", with our three month long waiting times to see a specialist, we are going through another row about doctor's pay. Local boob Justin had decided that having heard no real squawks when the raised personal income tax rates by another 4%, they should go after corporate taxes. The problem is that the doctors are incorporated because of the limited liability benefits. So when the income tax rate was increased, they just shuffled some of their earnings to their corporation, rather than as personal earnings. Now, with that option being shut down, they are very unhappy. The bet is that in the next rounds of provincial price setting, doctors are going to be demanding higher pay to compensate for their lost earnings. So the federal government, by wanting more cash from doctors, is going to ultimately cause provincial taxes to rise to pay for it. Either that, or as in the 1990s, when the last big fights over doctor's pay occurred, 1% of Canadian doctors will be decamping to the US each year. So it is not clear that you can fix these problems except by the obvious of (1) having individuals pay for their own insurance, and (2) allowing competition in prices at the provider level. Then maybe the human medical profession will become as efficient as the vets and dentists.

  • Sevo||

    "...Either that, or as in the 1990s, when the last big fights over doctor's pay occurred, 1% of Canadian doctors will be decamping to the US each year...."

    Or somewhere else, if Bernie gets his way.

  • Leo Kovalensky||

    Collective bargaining between doctors and the government sounds like a great situation for all of us...

  • Last of the Shitlords||

    This is why the progressives want global marxism. So there will be nowhere for those doctors to go.

  • Migrant||

    The tax payer funded UK system is cheaper, safer and more successful by far than the dysfunctional mess in the USA. Nobody is ever refused treatment due to lack of money or insurance cover.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Jujucat||

    And... Even IF the doctor wants a "pile of money", that wouldn't make him/her a bad doctor. In order to stay in business and stay competitive, the doctor would also have to be GOOD AT THE JOB. GREAT and they'd make even more "piles". Have you seriously not thought this far??

  • Earth Skeptic||

    Hey, lots of people want to be doctors. Or is that play doctor?

    Anyhow, when you sift through all those idealistic college students who just "want to help people" I hope you find enough with sufficient intellectual skills.

  • sarcasmic||

    I'm not saying that they should work for free. I'm saying that if people actually paid for medical services themselves, and that if these services were priced upfront, that competition would cause those prices to drop. Part of those dropping prices would indeed be a drop in pay for medical professionals. The third party payer system has artificially bloated their salaries because of the disconnect between the recipients of the services and the person who pays.

  • RG||

    That's my understanding of it as well. Other countries implemented single payer after WWII, which controlled thise payroll costs for the time being (before their populations began aging rapidly).

    IIRC, US doctors are paid more then their foreign counterparts.

  • Suckin' Seed||

    "US doctors are paid more then their foreign counterparts"
    ...then their foreign counterparts do what? Don't leave us hanging, man.

  • Mindyourbusiness||

    Sarc, I agree - with the proviso that government get the hell out of the medical business and stay out.

    What chance does a snowball have in Hell?

  • Migrant||

    The market is not a successful mechanism for healthcare. The tax payer funded UK system is cheaper, safer and more successful by far than the dysfunctional mess in the USA. Nobody is ever refused treatment due to lack of money or insurance cover.

  • MarkLastname||

    What part of the social contract says doctors have the right to prevent other people from becoming doctors in order to keep their own salaries high?

    That's called a cartel; I don't have any pity for taxi drivers who bought medallions only to find Uber underselling them, why should I have any for a doctor finding out he might not be able to buy a BMW because he has to cut his prices?

  • Dave Boz||

    Won't someone think of the poor Beemer salesman?

  • Unlabelable MJGreen||

    Won't someone think of the cartelists?

  • Jujucat||

    ^ teehee!

  • C. S. P. Schofield||

    But also because they have a strong Guild that keeps the cost of competition high. Before Florida State was accredited in 2005, there hadn't been a new Medical school since the mid 1980's, while an aging population made the demand for doctors rise dramatically.

    Doctors LIKE being rare and in demand. It give them prestige. Whch, frankly, only some of them deserve.

  • NotAnotherSkippy||

    We have plenty of law schools in this country and the world's biggest supply of lawyers. How are those competitive legal costs coming?

    Yeah, yeah, the bar keeps the supply "low" and yet somehow still much greater than the rest of the planet.

  • jerbigge||

    On a basis of increasing educational levels, the cost far outweighs the increase in performance on a historical basis. Basic principle of diminishing returns with cost increasing far faster than increased performance.

  • ThomasD||

    Yet it is amazing that things insurance does not pay for - cosmetic surgery and such - can prove so damn lucrative.

    Funny that.

  • Jen G.||

    It depends on the person. Some are very highly paid because the job they do requires a set of inherent traits plus years of training. They are paid based on supply and demand - not everyone has what it takes to do the job, even if schooling were less of an issue. Kind of like programmers.

    Some are highly paid because government regulations have artificially decreased the amount of supply.

    Pretty much all of the costs involved in health care come back to government regulation in one way or the other, though.

  • sarcasmic||

    Nothing that a free market can't fix.

  • Red Rocks White Privilege||

    Exactly. This is why I've been banging the damn drum on here relentlessly that price transparency has to be mandated. A "free market" is based on competition and choice, and what we have now is the opposite of that. When confronted with this fact, disingenuous, dishonest liberals always cite healthcare at the margins like heart attacks or getting smashed in a car wreck as an argument against price transparency because "you won't get on a website to price shop when you're dying!!" No shit, that's what insurance is for--as a hedge against catastrophic events. That's why you use insurance for rebuilding your smashed vehicle but the auto repair guy provides you an estimate for an oil change or brake repairs before he starts tearing the car apart, and you pay with cash or credit.

    The best part is that they actually are implying that providers who maintain websites as a standard practice are incapable of posting a list of basic preventative services and the charges for it. We had cheap healthcare back in the 1950s before the government started regulating the shit out of the market, there's no reason it can't go back to that. There's no logical reason that something which cost $1,000, inflation-adjusted 60 years ago should cost $25,000 today.

  • Earth Skeptic||

    Despite the fact that insurance spending distorts all markets (something about other people's money), you are correct that the average nitwit has a different concept in mind for health insurance compared to car insurance. We all got seduced into the idea that health insurance shoud cover basic human operating costs as well as catastrophic events. And thus the distortion has no limits.

  • Migrant||

    The tax payer funded UK system is cheaper, safer and more successful by far than the dysfunctional mess in the USA. Nobody is ever refused treatment due to lack of money or insurance cover

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Deven||

    I don't think the doctors are paid too much necessarily, we currently have to import, it seems, most of our doctors because the profession is just not that good of a deal to the average American.

    Average doctor salary is like 120k. So what, 60 bucks an hour? The costs stem from the overhead, the extra personnel for gov't regulations, and waste/inefficiency due to lack of true price signals, also caused by government.

  • JFree||

    Average doctor salary is like 120k

    Don't know where you pulled that number from but its wrong.

    Avg family doctor or GP pay (roughly 15% of doctors in the US vs 30-50% of doctors in other countries) is prob about 200k in the US vs prob about 120k in other rich countries

    Avg specialist pay ranges from $230k (internal medicine, psychiatry) to $400k+ (cardiology, orthopedics) compared to well under 200k in other rich countries

    The reality is that that pay is going to have to drop. And most likely via a combination of:
    a)French-type changes to medical training (where the French govt pays for medical training to meet the basic distrib of GP v spec that the taxpayer-paid system requires)
    b)Kaiser/Mayo/NHS/Australia type changes to doctor pay/risk - where more doctors are salaried rather than contractors or private practice.

    Won't happen until health% of GDP strangles the rest of the economy - but it will happen

  • CE||

    Forbes has average US family practitioner salary of 189K.

  • JFree||

    That's not far off 200k. My numbers came from Medscape 2017 Physician compensation survey (online but link is too long to insert)

  • Last of the Shitlords||

    It would lower the cost of malpractice insurance greatly if we had tort reform.

  • JFree||

    Sure. But what you're saying is that govt should force regular people into being harmed without recourse - in order to benefit the businesses of the wealthy in vague hopes that maybe they pass on the cost savings in their pricing (rather than pocket it themselves). That really smacks of plutocratic cronyism.

    Defensive medicine and overutilization is a real problem. But 'tort reform' simply assumes the only solution is a continuation of the status quo - individual practices. 'Physicians on salary' (like Mayo/Kaiser) allows for both team-based medicine - and a much more cost-effective pooling of insurance risks that doctors/hospitals themselves assume.

  • NotAnotherSkippy||

    Hahahaha. Right, salaries are the answer to supply instead of production. The first thing that would happen with everyone salaried would be massive 6wk vacations necause today id you're not working you're not getting paid.

    And holding up Mayo as an example is hilarious. They get special reimbursement for medicare/aid above community rates. And they basically apply the MIT method to medicine: throw every test at the patient and let the test tell you what to do. Cheap medical care ain't Mayo.

  • JFree||

    Mayo is generally a TERTIARY care provider. Their non-local patient base is overwhelmingly patients who have already been misdiagnosed or mistreated by specialists/secondary care - or who have complications that others admit that they can't deal with. Yes of course they are gonna be more expensive.

    But the reality is that they put their doctors on salary to minimize how expensive that sort of last-resort-care could become. And they have a team approach to minimize their own malpractice risk. And golly, they also assign a primary care doctor to that patient to manage the internal process because - they've found that a lot of their patients that come to them have only seen this specialist and that one and that one and that ad-hocness has itself become part of the problem.

  • JFree||

    And if a hospital wants to offer 6 week vacations to doctors - I'll bet they get a ton of great doctors applying there. Or are you one of those people who think vacations are just the devils work and that the only valid business model is a 80-hour sweatshop?

  • Earth Skeptic||

    I have seen data that suggest US GP's make 150% to 200% of GP's in other countries, but that specialist pay is near equal among developed countries.

    A big difference in spending is MUCH easier access to specialists in the US, for good or bad.

  • JFree||

    Agree re easier access to specialists in US. We have almost literally no controls except for Medicaid and Kaiser-type HMO's. Problem is specialists drive systemic costs higher - and that is the same in every country with every specialty and every kind of payment system.

    What we utterly fail at is access to GP's and family doctors. That's the only doctor 90% of us need for 90% of our lives. Those are the doctors who can reduce systemic costs, ensure healthier peeps - and if needed be the core provider in a free market system too (since patients will NEVER have the knowledge to choose specialists well). Their pay is not the core issue since they are the cheap element everywhere. Their role is - and in the US they are just tits on a bull

  • NotAnotherSkippy||

    See medicare. GP/FP docs are overrated for care but they do make great gatekeepers if you want to keep costs down.

  • JFree||

    They aren't overrated for care. We just don't have them in the US - and our pay-for-service model is exactly the wrong model to pay them.

    Medicare is a perfect example of how screwed up our system is. The GP for the older population is geriatricians. We have fewer in the US than Denmark (popn 6 million) does - and the number here is dropping even tho boomer/elderly popn is rising. That GP understands multiple chronic conditions, general/predictable deterioration, impact of slower rehabs, drug interactions that tend to be unique for that pop, etc. Yes that doctor will tend to have a gatekeep role (which should be considered a feature not a bug for a taxpayer paid patient). But they are also the only doctor who can keep that group healthy for as long as possible - prioritize care so it doesn't interfere with life as much - and know when its time to prioritize the bucket list instead.

    I don't know what you're smoking if you can't see the value of that as HEALTH care.

  • Migrant||

    Millions of Americans have trouble getting any treatment let alone specialists. Your system is crazy. In the UK I can get treatment for any medical problem for free. Nobody is going to be bankrupted by medical bills.

    The UK NHS is cheaper to run, more efficient and takes care of patients regardless of their status. We have longer life expectancy as well.

    If it were not for the deluge of deliberately false propaganda about 'socialised' medicine from your ideologues and vested interests, who profit from the chaos, the superiority of the UK system would be obvious even to US voters.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

    If it were not for the deluge of deliberately false propaganda about 'socialised' medicine from your ideologues and vested interests, who profit from the chaos, the superiority of the UK system would be obvious even to US voters.

    We've increasingly socialized our system and chaos has been the result. Fuck off, limey.

  • BYODB||

    Haha, no. I can tell you for an absolute empirical fact that payroll is not the biggest driver of healthcare costs. At all. It's maybe 10% of costs for every medical company I've ever worked for, and I've personally done payroll for some of them.

  • MarkLastname||

    What do you mean by medical company? Does this include hospitals?
    And are you referring specifically to doctors' salaries? All medical personnel? All staff? Because I dont believe for a moment that all labor costs amount to a mere 10% of healthcare costs.

  • BYODB||

    I'm talking about all labor that works for a hospital, period. All of them, from Doctor's to Janitors.

    You have absolutely no idea how much medical equipment costs, I assume, let alone facilities.

  • BYODB||

    And for the record, it's not just hospitals. I've worked for multiple hospitals, but I've also worked for less traditional, more innovative, medical systems as well that bring the hospital to you.

    Thinking that labor costs are driving the explosion of medical costs is one of the dumbest, non-supported arguments I've seen around here but it's hardly surprising.

    You think a Doctor is overpaid when a Petroleum Engineer blows their salary out of the water? Go and pull the other one. Sure, you can point at rare instances of certain high-demand physicians and try and extrapolate from there but you'd be lying through your teeth to do it.

  • BYODB||

    Correction to this below, just FYI

  • MarkLastname||

    I looked up aggregate statistics and found little; one thing I did fine:

    http://www.beckershospitalrevi.....venue.html

    According to them, on average, hospitals' labor costs exceed 50% of their operating revenue

    Interestingly though, doctors' salaries, in real term, haven't moved up much since costs of running a practice and buying insurance and whatnot seem to have eaten up most of the nominal salary increases.

  • Suckin' Seed||

    So what is the biggest driver of healthcare costs?

  • BYODB||

    The government.

  • ||

    But weren't you just saying that the cost of medical equipment is the primary driver? Is the government driving up the cost of medical equipment to the degree that it's drowning out everything else?

    Are you saying that you're finding that capital outlays far outweigh operating expenses in medical costs?

    Because I just got finished building a hospital, and I do know what medical equipment costs, and I have to agree with MarkLastname that I find this claim to be not immediately persuasive.

  • BYODB||

    No, I mentioned medical equipment as an example but if you look at where the expansions are in medical they aren't on the provider side they're on they regulation and administrative side I.E. government mandated positions that must exist or else, and people who strictly have a job because of government intervention. It's administrative bloat, and every graph I've seen on the subject makes that fairly clear.

    So while labor is actually the biggest share of expenses, over yes even equipment, it isn't necessary a problem with the Doctor's but rather all the added layers of labor that you are required to have by law or else.

    Ten percent is the low-end of labor expense that goes towards Doctor's specifically so that's my fault entirely and I'll quickly admit as much, but I don't think I've seen it go higher than ballpark 15%. I assume there are probably practices out there that go higher than that, but I would assume they would be outlier specialist practices rather than a health system but I doubt there are many of them.

  • ||

    Ah. Now that makes total sense, and I suspected that you maybe weren't counting administrative bloat in that 10% payroll number.

    If you're saying that the cost of various forms of compliance far exceeds the cost of providing actual medical care, that I can readily believe. A considerable amount of the cost of hospital construction is also tied up in regulatory compliance, not to mention the artificially-restricted market for medical equipment that drives up those costs as well.

    You wouldn't believe the we'll-get-to-you-when-we-get-to-you attitude of our medical equipment provider from whom we were literally buying millions of dollars worth of equipment. They very much had a "we're the only game in town" attitude.

  • BYODB||


    You wouldn't believe the we'll-get-to-you-when-we-get-to-you attitude of our medical equipment provider from whom we were literally buying millions of dollars worth of equipment. They very much had a "we're the only game in town" attitude.


    Yeah, I don't envy you that. I'd absolutely believe it though. Some of those pieces of radiology equipment are so expensive the mind boggles and the facilities to house them are equally insane.

  • MarkLastname||

    In many cases the equipment seems like the kind of thing you only need for one facility in a region. Granted, I'm only familiar with the 'scientific' technology: not everyone needs to be able to do deep sequencing, for example; you can send your samples to the nearest major metropolitan hospital to get that done. But each institution (or each department) wants the latest tech for itself almost for the prestige it seems, and will fight doggedly for funding to get it even it's redundant.

    I also wonder how much patents come into play. And I know the FDA has a frustratingly broad definition of 'medical device' that means you need like a 20 year monopoly to turn a profit since a product is liable to spend a good portion of that time in regulatory limbo.

  • ThomasD||

    Yeah, centralized planning. That will fix things just right.

  • JFree||

    That's a nice soundbite but I don't buy it. The US is WAY overteched and those machines are generally underutilized compared to other places. Just using MRI's ( a relatively cheap tech) as an example:

    The US has 35.5 MRI's per million people.
    Netherlands - 11.5
    Australia - 13.4
    Canada - 8.8
    France - 9.4
    Israel - 3.1
    New Zealand - 11.2
    China - 3.2
    Singapore - 8.3
    UK - 6.1

    You can argue that some of those other places are too low. But the reality is that 8-15 number is what is both a)medically necessary and b)sufficient to not require lines/rationing/travel. Our overcapacity merely results in spreading those fixed costs on fewer scans/machine resulting in higher prices. And the mere purchase of those is what results in the practice of defensive medicine too.

  • JFree||

    And the other thing re much of that - other countries view those hospital facilities as municipal infrastructure. They have less of it but distribute it better. The fixed capital expenses can thus be partially paid for via property taxes - because a good nearby hospital raises land values. The locale itself thus also captures the rent inflation over time and doesn't have to pass that on in the form of higher prices. It is a much cheaper way of financing longer-term capital expenditures that are tied to land - because bonds backed in last-resort by potential property taxes are MUCH cheaper than bonds backed by rapidly depreciating equipment.

  • And you believe that why?||

    In order to insert competition we need more doctors. The short term fix is allow more foreign tried physicians to practice medicine in the US. The long term solution is to tell the AMA where to shove med school limits. We also need to address the mess we have generated by using Medicare money to fund residencies.

  • albo||

    As long as you have guaranteed issue and community rating involved in a health insurance plan, it's NOT HEALTH INSURANCE. You can't have insurance without underwriting.

    Americans may want guaranteed issue and community rating in their health plan, but they ain't gonna like what they'll have to pay or give up for it.

  • BYODB||

    This. I'm sure giving everyone six billion dollars would also be extremely popular, but that doesn't make it possible.

  • ||

    Sure it is - we'll just use leaves as currency.

  • ThomasD||

    How about multi ply bleached paper. In long, perforated strips. Put it on cardboard rolls for easy of transport and storage.

  • ThomasD||

    Better yet, we just pay everyone in salt.

    Totally old school.

  • Heraclitus||

    Agreed. It's hard to believe that we still use this language after all the endless debates over the last 10 years. But it should be pointed out that a single-payer health care system has the enormous possibility of short-circuiting that bull puckey. It has no pretense of being "insurance" in the classical sense. It's kind of like the antithesis of the Libertarian fantasy of scrapping insurance all together and just paying fees for each service. It gets rid of the nonsense insurance system but substitutes a free market fantasy that makes no sense in a medical context.

  • ||

    It gets rid of the nonsense insurance system but substitutes a free market fantasy that makes no sense in a medical context.

    Why is the insurance system nonsense, and why does a free market system make no sense in a medical context? Do medical providers not want to get paid the same way other professionals do?

  • Ted Morgan||

    Many people think profiteering on healthcare in antithetical to basic decency. Make money on movies or popcorn or fancy cars. Not healthcare. People think it's disgusting because it is. That's why Sanders is so popular. Of course doctors should be paid, but insurance and pharm companies shouldn't make billions. It's not a phone or a widget, it's people's health and mortality, FFS. They're sinister, money-grubbing beast people.

    Step one is to remove profit incentives from insurance companies, like Germany. Non-profits pay salaries just fine. Have mandatory multi-payer contributions, like Obamacare (and Germany), and if people want to opt out of it (i.e. they're rich), they can get private insurance. That way everyone gets coverage, which is all Sanders is talking about.

    But, of course, you already knew all that. If you're honest, you might admit that the libertarian free market fantasy isn't scalable. Our healthcare murder scene is walking proof. It might work great in a small frontier town, but not for enormous, modern populations. Sh*t needs fixing. Sanders isn't wrong about that, even if his proposals aren't correct.

  • BYODB||

    Do you know how insurance companies make their 'profits'? It doesn't seem like it.

  • BYODB||

    And also this:

    Many people think profiteering on healthcare in antithetical to basic decency.

    So if someone thinks you making money off of your skills and labor, that you either paid for or took out loans at personal risk to pay for, you believe that they should be enslaved for the 'common good'. That is good to know since I'm assuming you have a problem with Doctor's being paid at a profit.


    Tell me this, perfect specimen of the New Soviet Man, do you give all your labor away for free? Or, if you don't, will you do so if I redefine whatever it is you do as a 'right'? Healthcare is not a 'thing' it is a 'service' that relies on essentially two thousand years of distilled knowledge to practice that has been regulated to the point of virtual extinction. You're a fool if you think something like that can in some way become a 'right' and remain the same thing that it is now in practice.


    Single-payer is slavery, but on top of that it's inefficient and has perverse incentives for everyone involved.

  • Earth Skeptic||

    Gee, Ted, anything else you want to add to the basic decency freeware menu? Speaking of menus, how about food? And since decent people want to sleep indoors, how about housing? And free transport, so we can get around? And of course in the modern age, we need digital networking, so we better supply free devices and access. And, and, and, and...

    So to be decent, we need to remove profit as motivation to create and provide any of these things, right? Cuz central planning has always made life better for decent people.

  • MarkLastname||

    "People think it's disgusting because it is. "
    Why is it more disgusting than making money off of food, water, or shelter? Should all of those be nationalized and turned into nonprofits?

    Your moral reasoning is beyond preposterous. You talk as though the doctors, their medical expertise, the machinery, the capital, and everything that coalesces to provide medical care to people is just there. It's just there in abundance waiting to be used by the sick. But some damned capitalist has taken over the healthcare mines and is trying to squeeze people!

    That's horse shit. Doctors and nurses and biomedical engineers and construction workers that build hospitals and investors that finance them aren't morally obligated to pitch in to keep you well just to take whatever you decide they'll get.

    What a market economy does, in health care every but as much in any industry, is drives profits down to costs, and costs down to what people are willing to pay for a given service. That's not a fantasy. It's a reflection of the reality of what it costs to provide health care (which is a fucking lot).

    And yes it's sad that open heart surgery doesn't grow on trees, but your socialist delusions don't change that fact.

  • ThomasD||

    The same people who have no trouble shelling out for the most expensive car their budget allows - be it a Honda or a Mercedes - will bitch about the price of their annual office visit.

    The truly funny thing is that it is often easier to do without the annual checkup than it is to do without a functional automobile.

  • Migrant||

    The UK tax payere funded NHS is cheaper, more efficient and treats everyone without charging - The US market system is unjust, inefficient, discriminates against the poor and can result in bankruptcy for health bills.

  • BYODB||

    Efficiency in healthcare means that those who may need healthcare, but are not a net boon to society, don't get healthcare because they are not value added to society.

    Somehow, this makes people like you 'moral'.

  • $park¥ leftist poser||

    Your income went up — you can't get this. Your income went down — you can't get that. You've got to argue with insurance companies about what you thought you were getting.

    I have literally never had this issue.

  • Citizen X - #6||

    Yeah, well, you probably didn't spend the first forty years of your life unemployed, either.

  • sarcasmic||

    I dunno. I keep getting raises and my income keeps going down. That's because health insurance keeps going up, because I've got to pay hundreds of dollars a month into an HSA to cover the extremely high deductible, and now that I'm divorced my federal withholding just went up a couple hundred dollars a month. My take home pay right now is about where it was before I got a $6K raise last year.

  • Juice||

    Why does your withholding go up because you got divorced?

  • sarcasmic||

    Google it. I can't explain.

  • BearOdinson||

    See below, but also, if you were married and declared "0" on your W-2, less would be withheld than if you were single and declared "0". However, you can essentially declare anything you want. As long as you make everything work correctly when you file, you are fine.

  • NotAnotherSkippy||

    If you're in the sweet spot of the middle class marriage is a tax break. If you're in the top or bottom decile (maybe quintile) marriage increases your taxes. Significantly.

  • Deven||

    Tax brackets are different for single taxpayers and married taxpayers. For example, a married couple filing a joint return with a combined adjusted gross income of $40,000 would be in the 15 percent tax bracket for the 2012 tax year. A single taxpayer with an AGI of $40,000 is in the 25 percent tax bracket.

  • Migrant||

    I pay zero for healthcare except what comes from general taxation which spreads all healthcare costs across the entire population. The US system is insane.

  • Brandybuck||

    Democrats: "Don't repeal and replace ObamaCare!"

    Democrats: "Repeal and replace ObamaCare with BernieCare!"

  • ||

    Sanders' refusal to describe a funding mechanism makes clear that he has not discovered a way around this problem. His only tactic is to avoid talking about it in any detail.

    This is a problem that has become endemic to both parties. It's like they've reached a silent agreement to just not talk about the fact that we're literally out of money.

  • BYODB||

    This, so much this. 20 trillion and counting. Absurd. At this point it seems irresponsible to vote for anyone that doesn't at least talk about it.

  • ||

    They really do seem to have bought into the idea that it doesn't matter, and that the only reason people like us think that it does matter is that we're ignorant rubes who don't understand the international monetary system.

    For the moment, it's sort-of-true that it doesn't matter, but it's a lot like Cersei's declaration that she's sure the Knight's Watch will maintain the Wall like they always have. Eventually the rest of the globe is going to get sick of this shit, and the bill's going to come due.

  • JWS||

    I saw this in an article:

    "'As a patient, all you need to do is go to the doctor and show your insurance card,' his campaign proposal said."

    So, if everyone is covered and everything needed is covered, why do I need an insurance card? Why can't I just walk into whatever medical building I see and demand service?

  • singlestack||

    They need to track utilization for the purpose of rationing care.

  • Unicorn Abattoir||

    To track how much of the people's assets you are consuming, and determine whether or not you are a wrecker.

  • CE||

    Isn't the requirement to get an insurance card an undue burden on the poor?
    Democrats say this about voter ID.

  • Migrant||

    If you lived in the UK the vastly superior NHS 'socialise' system will treat anyone without any cash or insurance transaction. As anyone can get ill at any time the cost is shared across all taxpayers, so no-one need fear getting ill. The US system is insane.

  • Sprague Pond||

    You can't just throw money at it irresponsibly. You have to rewire the entire sector.As California and Vermont have shown that single-payer costs as much as the entirety of their current state budgets, it will only work if you do everything Britain (and to a lesser extent the US military) do to make it happen. Big Pharma and health care provider (hospitals and physicians) profits and salaries will have to be heavily regulated, along with tort reform, rationing, Charlie Gard death panels et al. And in 50 years the result will be Third-World health outcomes, just like Britain and the VA are experiencing today, as well as loss of all the free-market medical innovations that are the reason our border hospital parking lots are clogged with Canadian license plates. If that's the consensus, then enjoy.

  • Domestic Dissident||

    Crazy Brooklyn Bernie's unlimited free health care warehouse and emporium! Bernie will beat anyone else's less than free price tag! Crazy Brooklyn Bernie: he and his prices are insane!!!!!

  • lap83||

    those clouds aren't going to yell at themselves

  • Tony||

    You have to understand, the more unlikely a thing, the more credit St. Bernie gets for proposing it. Meanwhile his colleagues are all sellouts and traitors for daring to propose anything that might actually happen.

  • MarkLastname||

    So is your objection that it's politically unrealistic, or that it economically unfeasible? If the latter, I'm curious to know why this is a bridge too far for you?

  • CE||

    Yup. Sort of like Ron Paul getting credit for voting no on everything, and Rand Paul being a sellout for trying to work with other Senators on stuff.

  • Sevo||

    Tony|9.13.17 @ 12:57PM|#
    "You have to understand, the more unlikely a thing, the more credit St. Bernie gets for proposing it"

    Bernie proposes energy from unicorn farts! Tony cremes his jeans!

  • Breeze5522||

    In addition to not being concerned about how to pay for this, idiots like Bernie Sanders completely ignore the incentive effects: with zero co-payment and extensive health care benefits available to all, demand will increase substantially, requiring greater government expenditures to support the system as well as decreased service quality. The service quality will decline even further given that, as noted by others, fewer people will choose to become doctors due to lower compensation and the constraints imposed by working under a government bureaucracy.

  • Adam330||

    The Rs first move should be to ask that CBO score this bill. When the score comes back as multiple trillions of dollars, it will make it much harder for the Ds to run on it.

  • Migrant||

    The UK NHS is has zero cost at the point of treatment, is cheaper and more efficient than the US mess and we live longer on average. You are utterly mistaken.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • BYODB||


    Today, Bernie Sanders will release a proposal for single-payer health care, co-sponsored by 15 Democrats.


    And thus we end up at a place where even Democrats are against the ACA. Needless to say, they still won't work with Republicans on reform. I wonder why?


    Note that I personally don't want them to work together, or do anything beyond repeal, but politically it makes these Democrats look like petulant children who are angry that they were promised a Unicorn and only ended up with a Donkey with a horn stapled to it's head.

  • Unicorn Abattoir||

    These days, you take what you can get.

  • Citizen X - #6||

    Democrats, or at least the more progressive ones, have wanted single payer for decades. The ACA was supposed to be a compromise measure - it was based on proposals that Republicans had been making as far back as Nixon, after all. The hallmark of a good compromise is that everybody walks away mad.

  • BYODB||

    Fair enough, although only a fool puts forward a compromise bill and continues forward when the people you're supposedly compromising with don't vote for the program at all. That isn't a compromise by any stretch of the imagination.

  • Citizen X - #6||

    only a fool puts forward a compromise bill and continues forward when the people you're supposedly compromising with don't vote for the program at all

    Allow me to introduce you to the U.S. Congress.

  • Adam330||

    "it would mean that most Americans never have to deal with an insurance company again."

    Why would you think this? You do realize that Medicare and Medicaid are actually administered by insurance companies, right? CMS only has a few thousand employees. They have contracts with a number of the major insurance companies to do the work of enrolling people and doctors, receiving and adjusting claims, paying claims, auditing, etc.

  • Rockabilly||

    Stick your commie plan up your commie ass. Fuck you Sanders, you're a piece of commie shit, move to Cuba.

  • Migrant||

    He can come to the UK - we have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Amercans and no fear of medical bils. Our system is cheaper, more efficient and better than the crazy US health market. Your are pathetically ignorant as well as foul mouthed.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Jerryskids||

    What have you guys got against free ponies?

  • Citizen X - #6||

    If you're against the government giving away ponies to everyone, that means you don't want anyone to have a pony ever!

  • Chuckles_the_Snarky_Piggy||

    Perfect! Now we are gonna need another tax hike to pay for the free government veterinary care for all the damn ponies.

  • someRandomIdahoGuy||

    How about universal coverage (NOT single-payer) AND a FREE market for health care? That's what I think we need. My idea is outlined at www.somerandomidahoguy.com.

  • Heraclitus||

    I like the part where Suderman points out that Health insurance profits are minimal. Notice the trick? Folks, it is the fact that even exist at all that stinks. They are an unnecessary middle-man. They do nothing to help provide medical services except extract economic rent from every medical transaction. The outrage is not over profits, but the fact that every time you visit your doctor you have to pay some cubicle-dwelling lackey to look over your visit, negotiate with the doctor, send you multiple statements and so forth. And they screw up a large percentage of the time. Note - this is not about profits. It's about waste.

  • ||

    The outrage is not over profits, but the fact that every time you visit your doctor you have to pay some cubicle-dwelling lackey to look over your visit, negotiate with the doctor, send you multiple statements and so forth

    Allow me to point out that you seem to 1) not understand the idea of collectivizing risk, and 2) don't seem to understand how insurance companies go about handling claims and pricing services that they cover.

    And wouldn't a government-run single-payer system just be an even bigger and less efficient "middle man?"

  • Adam330||

    And Bernie's system will fix this how? He wants every conceivable medical procedure, no matter how small, to be covered by this grand new insurance scheme. That means each and every one of them will be reviewed by some cubicle-dwelling lackey to decide whether and how much to pay the doctor/hospital/provider. And then, of course, there will be tons of errors and fraud, which will justify many other cubicle-dwelling lackies to provide oversight and audit of the first set of cubicle-dwelling lackies. It's a veritable jobs machine for cubicle-dwelling lackies.

  • esteve7||

    leftists arn't mad about middle men, they are just mad that it's not THEIR middle men. The government would be an even worse middle man.

  • esteve7||

    leftists arn't mad about middle men, they are just mad that it's not THEIR middle men. The government would be an even worse middle man.

  • Earth Skeptic||

    Sigh. Ranting about "profits"--this could be a NY Times comments page.

    If that is a trigger word for you, then replace "profits" with "break even".

    And yes, I get your point about the costs associated with a separate payment industry. So, you could just pay your doctor cash for services--something I think is the best way to fund routine care. And when you face a catastrophic health issue and associated large costs, you can rely on your non-profit insurance co-op. Just realize that they will have staff and management and overhead, and charge a fee for their service. And if it was me, I would indeed want the insurance co-op to watch out for fraudulent or frivolous claims.

  • Red Rocks White Privilege||

    The outrage is not over profits, but the fact that every time you visit your doctor you have to pay some cubicle-dwelling lackey to look over your visit, negotiate with the doctor, send you multiple statements and so forth.

    Yeah, the problem is the insurance company, not the doctor who charges a massive fee that the insurance company then tries to negotiate down. Fuck off with your misdirected accusations. Blaming insurance companies for the high cost of healthcare is like blaming lending agencies for the high cost of college tuition.

  • Sevo||

    Heraclitus|9.13.17 @ 2:49PM|#
    "I like the part where Suderman points out that Health insurance profits are minimal. Notice the trick? Folks, it is the fact that even exist at all that stinks."

    Oh, goody! A new imbecilic lefty showing up to prove once again that lefties must be too stupid to tie their show laces!
    Fuck off, slaver.

  • MarkLastname||

    Do you... do you know what insurance is? It's you paying collateral so you can borrow from expected future earnings to pay for potential unforeseen costs today. If it were so redundant, no one would buy it.

  • Migrant||

    We in the UK have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Amercans and no fear of medical bils. Our system is cheaper, more efficient and better than the crazy US health market

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • ||

    "I think the American people are sick and tired of filling out forms,"

    So let's give them a system run by people who LOVE forms!! BRILLANT!

  • Adam330||

    This was is truly awesome. Who believes that government, of all institutions, is the one that will cut down on the number of forms? The number of forms I have to fill out for my kid to be in the free public school is just mind numbing (and nearly all of them make me repeat the same damn information over and over again). And then of course there's the federal tax system. My god people are stupid.

  • Uncle Jay||

    RE: Bernie Sanders' New Single Payer Plan Is a Wild Legislative Fantasy

    I love Comrade Bernie.
    I don't know of any other comedian that make me laugh the way he does.

  • Migrant||

    we have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Amercans and no fear of medical bils. Our system is cheaper, more efficient and better than the crazy US health market. We laugh at the idiotic free market loons who have turned the US system into a bad joke.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • ||

    Since this bill stands absolute zero chance of passing the Senate, much less the House, much less the White House, how is this not just a bunch of bullshit political theater?
    Why should anyone give a shit?

  • macsnafu||

    Because too many people will believe that Bernie's plan is possible, even practical, and use that in every argument and debate about healthcare in the near future, ruining the chances of any worthwhile and reasonable health care reform.

  • MarkLastname||

    Because in the off chance the Democrats win the senate next year, something like this could pass the senate. In the more likely chance they retake the Senate in 3 years, it likely will pass the senate. And by then at least a few Republicans will have begrudgingly jumped on the bandwagon, so they may not even need to take the house to do some serious damage on this front.

  • macsnafu||

    This is why Bernie made such a good presidential candidate. His ability to make impossible promises with a straight face! Even Hillary had trouble doing that - she kept twitching.

  • Liberty Maniacs||

    Why the hell would anyone think Americans give a shit about what it costs? $20 trillion in debt. 16 years in no-win endless wars for trillions more. Fuck, it took America going through the worst recession since the 30s to even begin to admit that throwing $500k mortgages at unemployed people and strippers might cause a few issues. This shit is coming. Buckle up. America has gone full retard.

  • JFree||

    Gotta admit one thing. This proposal at least makes it possible to have an actual debate about healthcare in the US. The current system - and every system for at least 50 years - has done absolutely nothing and is a complete clusterfuck of confusion for anyone even contemplating a change in situation/employment/geography. NO OTHER service/product is even remotely as difficult to comprehend.

    I think the whole 'fed govt does everything' argument is beyond silly. But hey - maybe a reform Medicare/aid/employer/other - and move it to the state/muni level to operate - can work. At least in Europe, there are serious comparatives about different healthcare systems - http://bit.ly/2wqASqe . That could be very useful in the US for any company looking to expand. Can't do that in the US unless you hire benefits consultants and assume all the excessive costs yourself. Not to mention that that sort of comparative can also begin the process of forcing costs down - since states can compete just as well as any other market force.

    Our current system is absolutely harming our economy and esp smaller growing companies. It's got to change.

  • MarkLastname||

    Right, and at least September 11th made it possible to actually have a debate on remodeling urban skylines. Jesus Christ.

  • Migrant||

    We in the UK have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Americans and no fear of medical bils. Our system is cheaper, more efficient and better than the crazy US health market which is distorted and crippled by the profit makers.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Ned Netterville||

    He wants to venezualize the US economy starting with the healthcare industry. Socialism uber allez is his cry.

  • Migrant||

    We in the UK have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Americans and no fear of medical bils. Our system is cheaper, more efficient and better than the crazy US health market which is distorted and crippled by the profit makers.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Ned Netterville||

    Maggie Thatcher observed, "The problem with socialism is eventually you run out of other people's money."

    OPM: Sounds like opium, is equally addicting, stands for Other People's Money--forcibly extorted. Once you start snorting it, there is no stopping until Maggie's outcome prevails.

  • Migrant||

    Thatcher destroyed many successful public sector organisations, reduced pay for health staff, crippled our NHS so badly with vicious cuts that we are still not fully recovered and was the most hated PM since WW2. Despite this we in the UK still have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Americans and no fear of medical bills. Our system is cheaper, more efficient and better than the crazy US health market which is distorted and crippled by cynical profit makers.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Sixty Ville||

    The single payer in question is Mr. Else. Mr. Someone Else, a well-heeled rich gentleman who has been the source of funding for many Leftist idiocies, even if he didn't want to in the first place.

    I suspect that Mr. Else may be slowly becoming aware of the economic outrages inflicted on him by the Left, and will soon be turning off the money tap, lowering the blinds, locking the front door, and telling his manservant Barack to announce to visitors that Mr. Else is longer at home to Democrats with their hands out.

  • Migrant||

    We in the UK still have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Americans and no fear of medical bills. Our system is cheaper, more efficient and better than the crazy US health market which is distorted and crippled by cynical profit makers. You live in a fantasy world created by people who treat you like an idiot and accumulate billions for themselves.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • Richard Grieco||

    I pay like $2,000/yr for health care for both myself and my wife. That's less than 1% of our combined income. All of our needs are currently being met.

    Why would I sign up for a plan that costs both of us a ~10 percentage point increase to our payroll taxes, even if it covers everything under the sun with no additional cost to us? We would be paying 10x as much. I want a Honda, not a Lamborghini.

    (it feels wrong comparing govt run anything to a Lamborghini)

  • MarkLastname||

    Compare gov't run things to Jaguars instead. You pay a shit ton for it and it still doesn't work.

  • jerbigge||

    Historical cost of US health care was pretty much a parallel to what countries like Canada paid for health care through the 1960's. Note too that some European countries cover the cost of medical educations which allows doctors after graduation to charge far less because they don't have to pay off a quarter million or so in student loans. Prior to 1938, prescription laws only applied to narcotics. This meant that people could often rely upon the local druggist for help with less complex medical problems that could be cured or dealt with by taking medicine. Also compare the amount of "paperwork" that a US doctor has to deal with as compared to doctors in other developed countries. Medical malpractice is a concept much better known in the US than in the rest of the developed world. Then the rest of the developed world negotiates drug prices with the drug companies, something that is not allowed here in the USA.

    Add all of this together and it becomes more understandable why Americans pay far higher prices for health care.

  • Sevo||

    jerbigge|9.13.17 @ 8:55PM|#
    "Note too that some European countries cover the cost of medical educations which allows doctors after graduation to charge far less because they don't have to pay off a quarter million or so in student loans."
    So the taxpayers are paying for the education through taxes and not through medical fees, and this legerdemain is handled by the government, and that is supposed to be cheaper?

    "Then the rest of the developed world negotiates drug prices with the drug companies, something that is not allowed here in the USA."
    Yes, they do that by passing the costs to make the companies whole back on to those countries which DON'T fix prices: The US (which can afford it, even if we don't like it), and those oh, so prosperous African countries, all so the poor, poor, Canuks can brag about cheap pharms.
    And, if everyone did so, you had better be happy with the current meds; no nobody's gonna risk the costs of development.
    Wonderful!

  • Migrant||

    we in the UK still have a socialist healthcare system which does not charge patients anything and no insurance companies required. We have a better life expectancy than Americans and no fear of medical bills. Our system is cheaper, more efficient and better than the crazy US health market which is distorted and crippled by cynical profit makers.

  • Red Rocks White Privilege||

    The UK NHS is has zero cost at the point of treatment

    No, there's a cost--it's disguised by high taxes.

    is cheaper and more efficient than the US mess

    Ours was cheap until the government started offering public insurance plans.

    we live longer on average

    Which is utterly irrelevant considering that this is calculated differently in our countries.

  • tommhan||

    Sanders should really hit the comedy circuit.

  • Migrant||

    The UK National Health Service, (NHS) tax payer funded and free to all who need it, is cheaper and superior to the US system. No sick person in the UK need ever fear being refused treatment or bankrupted by the profit seekers who distort this basic human need for medical care.
    Americans are treated to much feeble and dishonest propaganda about why the NHS is supposedly not a good idea. One can only conclude that the default prejudices against anything which demonstrates a successful 'socialised ' healthcare system prevents any intellectually honest assessment of the NHS, the Sanders plan or any other rational alternative to the chaotic US health market.

  • Red Rocks White Privilege||

    Fuck off, limey.

  • jerryg1018||

    Bernie is using the same snake oil to sell his Medicare For All healthcare that Obama used to sell the Affordable Care Act. Bernie is promising the same lower health care costs with greater coverage. That's like GM saying you can save money by buying a fully loaded Cadillac instead of a Chevrolet Volt.
    Like Obamacare, Bernie wants to eliminate employer provided plans which, since they are self funded usually offer better coverage at less cost then insurance industry plans.
    Bernie is also greatly exaggerating the difficulties of dealing with the health insurers.
    With the advent of computers and standardized coding for procedures and treatments this problem has been practically eliminated.
    Bernie is not really concerned with providing better healthcare but rather garnering votes to propel himself into the White House with a promise of "Mo free stuff." The blatant fact that his Medicare For All is a financial fantasy is irrelevant.

  • Queer and Pleasant Danger||

    It worked so well in his tiny home state, let's roll it out everywhere!

    http://www.politico.com/story/.....ont-113711

  • GroundTruth||

    Argh.... they keep missing the point: IT IS WRONG!

    Call it what you want, it is socialism, which is theft at the point of a gun.

  • Red Twilight||

    There is some kickass neutral analysis by "libertarian" reason.com

    What is this? Six, seven articles on a UHC plan that will never pass getting so much coverage because this lets all the Republican mess go undetected.

    Keep it up!

  • swampwiz||

    There is something to be said for the chaos that is inherent in the current system, and it would to make it so that someone transitioning out of Medicaid could simply buy into the Medicaid plan; of course, this could go both way as someone who is not on Medicaid but thinks that he might have to go on it could buy into it as well. In this scenario, the only thing that would change is the amount of premium that the subscriber would need to pay.

    Outside of this, I don't see the benefit of forcing everyone to go to a MediSomething-For-All system; let folks get angry at the fact that they are getting some of their pay diverted to pay for expensive coverage (expensive in part to make up for the cheap rate that Medicaid pays).

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