MENU

Reason.com

Free Minds & Free Markets

Bernie Sanders' Medicare-for-All Plan Will Cost $32 Trillion Over 10 Years

Yes, that's trillion with a "t."

Alex Edelman/CNP / Polaris/NewscomAlex Edelman/CNP / Polaris/NewscomA plan to bring single-payer health care to the United States by expanding Medicare to cover nearly all Americans would cost more than $32 trillion over the first 10 years—and paying for it would require a doubling of current tax revenues, plus some.

That's the bottom line in a new study released Monday by the Mercatus Center at George Mason University, a free market think tank. The analysis attempts to apply a price tag to the single-payer proposal backed by Sen. Bernie Sanders (I-Vt.), otherwise known as the "Medicare-for-all" plan. Sanders' plan would see the federal government replace private health insurance that Americans currently receive as a benefit of employment or purchase independently, and would have the federal government become responsible for current state-level health care spending.

Even with conservative cost estimates—conservative because the estimate assumes, as Sanders does, that the single-payer plan would deliver savings in administrative costs and drug prices—the Medicare-for-all plan would require an "unprecedented" increase in government spending, writes Charles Blahous, the study's author.

"Doubling all federal individual and corporate income taxes going forward would be insufficient to fully finance the plan, even under the assumption that provider payment rates are reduced by over 40 percent," says Blahous, who was a health policy advisor to President George W. Bush and served as a Medicare trustee during the Obama administration. "Such an increase in the scope of federal government operations would precipitate a correspondingly large increase in federal taxation or debt and would be unprecedented if undertaken as an enduring federal commitment."

Instead of responding to the details of the Mercatus analysis, Sanders attacked the think tank's connections to the Koch Brothers. In a statement to the Associated Press, Sanders called the report "grossly misleading and biased."

But the Mercatus study is roughly in line with other assessments of how much it would cost to implement a single-payer health care program in America. A 2016 study from the Center for Health and Economy, a centrist health policy think tank, said Sanders' Medicare-for-all plan would add $27 trillion* to the federal budget deficit over the first decade. An Emory University analysis of Sanders' plan estimated that it would require $25 trillion in new federal funding.

It also fits with what some states have found as they have explored the idea of state-level single-payer plans.

Vermont experimented with single-payer health care a few years ago, but ultimately abandoned the project in 2014 because it was too costly. In Colorado, voters rejected a proposed single-payer system in 2016 when faced with the prospect of increasing payroll taxes by 10 percent to meet the estimated $25 billion annual price tag.

More recently, lawmakers in both California and New York have passed legislation to create single-payer health care at the state level, but both ran into difficulties when it came to figuring out how to pay for them. New York's single-payer plan would have required doubling (and possibly quadrupling, depending on which projection you believe) the state's tax burden, while California's single-payer legislation would cost an estimated $400 billion—more than twice the size of the entire state budget of $180 billion.

Figuring out how to pay for a single-payer system remains a serious problem for supporters of the idea. With more than $21 trillion already on the national credit card, it would be beyond irresponsible to pass a wildly expensive overhaul of the health care system without adequately funding it. Supporters of single-payer will have to convince Americans that it is worth paying twice (or more) as much in taxes in order to get "free" health care (and abolish premiums, co-pays, and deductibles).

Progressives seem prepared to make that sales pitch. Writing at the People's Policy Project, a progressive think tank in favor of single-payer, Matt Bruenig makes the case that reducing health spending is a trade-off worth making. "Rather than paying premiums, deductibles, and co-pays for health care, people will instead pay a tax that is, on average, a bit less than they currently pay into the healthcare system and, for those on lower incomes, a lot less," he argues.

While Bruenig is right that the Mercatus study shows that national health expenditures would fall*, Blahous is merely accepting Sanders' projected savings there. And it's probably right to be skeptical of those assumptions. Even though single-payer advocates point to potential administrative savings by having the government step-in to replace health insurance companies, but those numbers usually require a degree of deception—for example, not counting current Medicare costs as "administrative costs" of the existing health care system.

Beyond that, Blahous notes that increased demand for health care—eliminating co-pays and deductibles means people will get treatments they otherwise wouldn't—wipes out the savings achieved by reducing drug prices.

Moving to a single-payer system also comes with costs that aren't captured by a balance sheet. Much of the outcry over the implementation of the Affordable Care Act revolved around the disruption of health care coverage in the individual market. But Obamacare caused a few million Americans to move from their existing health insurance plans. Moving to single-payer means a disruption for literally everyone.

Single-payer health care may very well be an improvement on some aspects of the current American health insurance system, which is a weird mish-mash of overlapping programs, subsidies, mandates, and highly regulated markets that often makes little coherent sense. At the very least, a debate over a robust overhaul of the system is badly needed.

But part of that debate has to be about paying for it. So far, that's been a stumbling block for progressives. In polls, support for single-payer health care declines substantially after respondents are told about the associated costs.

Those trade-offs must be fully understood—not just by health care policy wonks, but by average Americans—before single-payer proposals can be seriously considered. Abolishing the disaster that is the American health insurance system sounds great, but government-run health insurance will be one of the costliest undertakings in the nation's history.

CORRECTION: This post has been updated to correct the amount that the Center for Health and Economy estimates Sanders' Medicare-for-all plan would add to the federal budget deficit over the first decade. It is $27 trillion, not $27 billion. This post has been updated to reflect an update in Bruenig's own post.

Photo Credit: Alex Edelman/CNP / Polaris/Newscom

Editor's Note: We invite comments and request that they be civil and on-topic. We do not moderate or assume any responsibility for comments, which are owned by the readers who post them. Comments do not represent the views of Reason.com or Reason Foundation. We reserve the right to delete any comment for any reason at any time. Report abuses.

  • loveconstitution1789||

    But do I get to keep my doctor?

  • Brandybuck||

    One will be assigned to you. Works great for defense attorneys, can't see any problems with government appointed doctors.

  • juris imprudent||

    Goddam, next proggie friend talking this up gets "so, if you're arrested and charged with a crime, you're going to rely on the public defender, not some high-priced private attorney, right"?

  • PaulS||

    Wouldn't all doctors become government employees (or contractors)? Either way they could easily be made immune from suits - I know this is a legal blog but might as well point out that if all liability etc was removed from the health system there would be immense savings. And much lest risk to providers as it would all be transferred to the patient

  • Last of the Shitlords||

    So far, even with all the socialist bullshit, there has yet to be the slightest effort to provide any tort reform whatsoever.

  • Mickey Rat||

    Does your doctor like to be consistantly paid below cost?

  • Fred G. Sanford||

    If the pay scales are the same as Medicare, they won't be paid below cost. Indeed, the AMA has a voice in how much Medicare pays.

  • rudehost||

    That must be why doctors are actively dropping medicare and medicaid patients you know because doctors are always looking for a way to not make money. Inadequate reimbursement rates from medicare/medicaid are a well understood problem and not controversial.

  • DrZ||

    Your doctor will quit and be replaced by a government employee. Government employees are willing to take less salary for other things such as a generous retirement and being un-fireable....you know public unions and all that.

    It will also be a benefit for Democrat politicians who will sit opposite the union at the bargaining table so that everyone "wins" (wink, wink).

  • Flinch||

    No, no. Your doctor will be made a government employee: all his checks will come from Treasury. Dig back to Hillary Care from Bills first term and recall that she was set to criminalize anyone performing fee for service outside the system if they took government money. Fast forward to 2012 and the Whistleblower Protection Act which was written to protect... congress! Government employees were largely written out of protections. Now combine the two. There will be a blizzard NDA's so that doctors can't complain to congress or the media, followed probably by the SEIU which will be lined up ahead of time to offer "assistance" to the disgruntled that need someone to talk to. Too bad it will be a brick wall, and too bad they didn't stay out of medical school and go cut grass for a living: their plumber will make 3x what they do at the end of the day.
    You'll "keep your doctor" [maybe], but he won't be practicing medecine - just following [sub]standard of care dictats from on high as innovation comes to a screeching halt, Soviet style. You'll probably have to know your congressman to change doctors. Bernie is straight from hell.

  • Earth Skeptic||

    Hardly speaks Engish so hard to tell.

  • Heraclitus||

    No one is crying for our overpaid doctors. I would be willing to pay for their medical school though so they can stop whining about their loans. Throw in malpractice insurance. There. Now they can stop crying about still making more money than 99% of us, even at lower reimbursement rates.

  • Cy||

    You need to pass it so you can find out what's in it... duh!

  • $park¥ The Misanthrope||

    Yeah, but GDP will work out to about $200 trillion over those ten years so this is just a drop in the bucket.

  • TrickyVic (old school)||

    It's not like the GDP is a bank account from which the government can spend.

    Now if government seized all the companies involved in domestic production you might be on to something.

  • Earth Skeptic||

    Why stop at domestic--grab all the production we can!

  • Fuck you, Shikha (Nunya)||

    Democratically, of course. Unless they resist. Then just take it.

  • Unable2Reason||

    Good one!

  • Rossami||

    I'm not sure how 15% counts as "a drop in the bucket". I usually think of some tiny fraction of a single percent when I hear that phrase.

    But running the numbers a little differently, the 2017 US GDP was about $19.4 trillion. Government spending in 2016 (the last year for which I could find data) was 37.8% of GDP or about $7.3 trillion. Add 3.2 trillion per year to that and government spending goes over 54%. Not as bad as Zimbabwe (recently estimated at 98%) but worse than even the most profligate of the EU countries.

  • Just Say'n||

    Of course a Koch funded outlet wouldn't account for all the money we'd save if we just confiscated the property of Kulaks and then eliminated them.

  • Get To Da Chippah||

    True, we might be able to fully pay for the program for an entire year!

  • JWatts||

    "True, we might be able to fully pay for the program for an entire year!"

    That's just short sighted thinking. You just need to broaden the term kulak to include all "rich" sick people. And voila, instant savings!

  • BestUsedCarSales||

    People need to ask themselves the question of why healthcare is so expensive to begin with. What can be done, perhaps deregulate?, to bring down costs. Because just covering the costs with tax money isn't making it cheaper in any real sense.

  • Brandybuck||

    The core problem is the third party payer. Goverment of course exacerbates the problem, but the whole insurance plan thing is a mistake right from the get go. Insurance should be to mitigate risk, not a payment plan for the routine. You'll still need it, or something like it, for catastrophic illnesses and stuff, but it's horrible as a way to handle routine health care.

  • MasterThief||

    Where is this discussed in mainstream society? It simply isn't. Save for libertarians, some conservatives, and a microscopic number of wonky liberals there simply isn't an in depth conversation of what leads to the astronomic costs we experience. Our healthcare model needs to be completely reformed beginning with the role of insurance. Unfortunately, in order to do this the government needs to deregulate and society would have to begin taking responsibility for their health and be willing to pay directly for health services. It's so much of an easier sell to tell people that all their needs will be taken care of as well as the needs of those poor people. People are too lazy to not grasp at a handout and something they wouldn't have to think about anymore.

  • Qsl||

    The entirety of it though is so complex that if you implement a cost saving measure here, you increase a cost there, and so the whole becomes robbing Peter to pay Paul.

    And honestly there isn't going to be a complete reform without a restructuring that puts single payer on the horizon.

    I could even see a very, very limited national plan just to break the current apparatus, but without controls to ensure it stays that way, I shudder at what it will become.

  • Brandybuck||

    Well the obvious first step seems to me to move to insurance premium vouchers for the poor. If the underlying problem all this towering pile of shit is mean to solve is how the poor get health care, then let's start there. Step two is to stop making insurance mandatory and legalizing pay-for-services health providers.

    We can't get to a market system overnight because we didn't get to hyper-corporatized healthcare overnight. But we can start working in that direction step by step.

  • Happy Chandler||

    Obamacare is premium vouchers. It is payment from the government to insurance companies.

    Pay for service providers are almost every provider. You are free to always pay cash prices for care. Most people can't afford six figure treatments if they get cancer.

  • TrickyVic (old school)||

    Yeah, but your going to pay their over inflated charge amount. Not the allowed amount that Medicare or Medicaid pays out.

  • DrZ||

    They are paying six figure treatments are caused in large part by first dollar coverage by medicare and private insurance.

    The question that needs asking is will this six figure treatment be less if medicine were consumer driven rather than politically driven. Single payer will not take the politics out of medicine, it will likely make it worse.

    Put consumers in charge of purchasing their own medicine and add to that price transparency and true catastrophic insurance and my bet it is that the cost of medical services will drop - like a rock.

  • Red Rocks White Privilege||

    Most people can't afford six figure treatments if they get cancer.

    These are treatments on the margins, and hardly an argument for universal healthcare.

  • Fuck you, Shikha (Nunya)||

    You mean the cancer stuff that people could get cheap catastrophic only plans for before obamacare?

  • NashTiger||

    The first thing that needs to be repealed is ERISA.
    Then COBRA needs to be repealed and replaced.
    Then the Pre-X clause of Obamacare, and, well, all the rest of Obamacare
    Individual Insurance Premiums need to be more tax advantaged than Group, not less. And everything must be fully portable or renewable for life, but get caught without Insurance for more than a couple of months during unemployment, and you get no shield from the consequences

  • juris imprudent||

    Way too many people believe that insurance is supposed to be like govt and Santa Claus.

  • Holmes IV||

    This is true but also true is the fact that governments (like Canada) limit the income a company can make from certain meds. if the company wants to sell those meds there they have to abide by the price fixing from the government (and, afaik, those prices are not subsidized). So those costs get passed along to other nations with less central planning. Essentially the US system is subsidizing much of the world's drug costs.

  • Happy Chandler||

    That's not the way the markets work. If Canada increased how much drug companies could charge, they would have zero incentive to lower the cost in the US. It would go straight to profits. Independent markets are independent.

  • Sevo||

    Happy Chandler|7.30.18 @ 4:23PM|#
    "That's not the way the markets work. If Canada increased how much drug companies could charge, they would have zero incentive to lower the cost in the US. It would go straight to profits. Independent markets are independent."

    ^This is the way idiot proggies "think"
    Dumber than dirt.

  • Happy Chandler||

    You think the Canadian market has an effect on the US market?

    You don't think that the makers charge what the market will bear? That, out of the goodness of their hearts, they'll reduce prices in the US because they are making better profits elsewhere?

    You haven't a fucking clue about basic economics. You're knowledge basically comes up to "I don't have any idea, but fuck you."

  • ||

    You don't think that the makers charge what the market will bear?

    Yes, they will - meaning that makers who make more of a profit in Canada can then lower prices in the US to capture more market share, which then puts pressure on their competitors to drop prices in order to maintain their market share.

    You haven't a fucking clue about basic economics.

    Be careful with those rocks.

  • Happy Chandler||

    If they can make more money by lowering the price, they already would have. Canada has nothing to do with it. If they weren't making money in Canada, they wouldn't sell there.

    Prices are set to maximize profit. If lowering the price in the US would increase profit, they'd do that. If raising the price would maximize profit, they would do that. Where in the supply and demand chart does their profit in another country matter?

    This is even more so in something like pharmaceuticals, where the marginal cost is a small portion of the total cost.

  • ||

    If they can make more money by lowering the price, they already would have.

    Correct. And as you say, the fact that the prices are where they are indicate that the companies probably can't lower prices in the US without losing money.

    Canada has nothing to do with it.

    Except that if they make more of a margin in Canada, they can survive on less of a margin here.

    Now, if there were only one company making the drugs here, then you would again be correct - they would have no incentive to lower those prices.

    But if we were to have market competition, then the above-mentioned competitive forces would be lowering prices.

    See?

  • Robert||

    What kind of nutty biz thinking is that, Square Circle? The fact that they can stay in biz making a certain amount on drug x has no bearing on what they think they should charge for drug y.

  • Fuck you, Shikha (Nunya)||

    Imagine that, market dynamics require price signaling. In prog land only government can price signal.

  • EscherEnigma||

    Nah. The "core problem" is that the most expensive health care is also the life-critical health care. And that's when people go full "money is no object", including money they don't have.

    And when people will literally spend themselves into the poor house for a service, the only real limit on that service is how much service-providers are willing to charge.

    And that's before we talk about the problems of delayed-payment vs. upfront, the difficulty in "shopping around", how people under duress don't make good decisions, and so-on.

    Put simply, ever capitalistic mechanism that usually works to keep prices down is much much weaker when it comes to medical care then for other services.

  • BYODB||


    Nah. The "core problem" is that the most expensive health care is also the life-critical health care. And that's when people go full "money is no object", including money they don't have.

    What, no mention of supply? Goodness.

  • EscherEnigma||

    Correct. No mention. Because my point is that when people will spend everything on some service, then the price of that service will always trend towards everything.

    The supply/demand balance is one of the many other factors that usually restricts such growth, but doesn't work in this case.

  • JunkScienceIsJunk||

    100% agree. Health care is relatively unique in this way.

    And that sucks, because it's a lot harder to "fix".

  • DrZ||

    "Correct. No mention. Because my point is that when people will spend everything on some service, then the price of that service will always trend towards everything."

    The fallacy of your argument is that "people" are not spending everything, insurance companies and medicare are spending "everything".

    Also, cash-only surgical centers are proving that costs of many surigical procedures can be done at much lower prices than those that are paid for by insurance companies or the government.

    More consumer, more price transparency and prices will settle to those at which we get what that for which we are willing to pay.

  • rudehost||

    Water fits this category as does food yet supply competition works just fine to keep prices reasonable. Lack of food will kill you faster than most diseases. I am more than a tad skeptical that the critical nature of a service leads to spiraling prices. There are dozens or hundreds of counter-examples that suggest otherwise.

  • MarkLastname||

    This is utterly false. When hospitals are allowed to set their own prices, areas with high hospital density (more competition) have lower prices; when prices are fixed, high density area hospitals have better quality care.

    You may be willing to spend a trillion dollars for a service, but if someone is offering it for a billion, you'll go there instead. Supply matters (indeed, if the market is competitive it's the main thing that matters). Theory and practice alike demonstrate this in healthcare as in any market. It's a thoroughly refuted article of faith among leftists that competition doesn't occur in health markets so we need to socialize them.

  • JunkScienceIsJunk||

    He's not saying there's no effect of competition. He's merely saying the balance is tipped in favor of the providers. This has an effect on price. It's fully consistent with the notion of supply and demand... it's just that the demand is outrageously high in this case because it's one of the relatively few things essential for survival that exhibits significant scarcity.

  • turco||

    ..but rare. Disease is common enough to be a problem, but is still unpredictable.

  • Happy Chandler||

    We've already taken much of end-of-life care onto the federal government, through Medicare. It is effective and cost-effective.

  • EscherEnigma||

    I'm going to assume from "It is effective and cost-effective." that you're being sarcastic and think that I'm arguing in favor of more government involvement in healthcare.

    In which case you would be wrong. I'm pointing out why medical care is largely impervious to normal capitalistic pressures, I am not advocating any given solution.

  • Happy Chandler||

    I'm referring to the fact that Medicare is extremely popular and delivers quality care more efficiently than the private sector.

  • Sevo||

    Happy Chandler|7.30.18 @ 5:20PM|#
    "I'm referring to the fact that Medicare is extremely popular and delivers quality care more efficiently than the private sector."

    You're full of shit.

  • EscherEnigma||

    I'll give you "popular".

    The problem with "efficiently than the private sector" is that it's an untested hypothesis that, at this point, America at-large is unwilling to test. But suffice to say, Medicare and Medicaid are growing in costs the same as everything else.

  • Happy Chandler||

    Growth from 2010-2017 for Medicare averaged 1.5% per capita, much slower than private health insurance. Much of this was due to ACA reforms, particularly ending the overpayment to Medicare Advantage because the only way private insurers could compete with traditional Medicare was to get more money. The failure of Medicare Advantage to compete on a level playing field shows that the private insurers can't provide the service and cost of traditional Medicare.

  • Red Rocks White Privilege||

    Growth from 2010-2017 for Medicare averaged 1.5% per capita, much slower than private health insurance...The failure of Medicare Advantage to compete on a level playing field shows that the private insurers can't provide the service and cost of traditional Medicare.

    Because those costs, which are caused by underpayment by Medicare/Medicaid, are shifted onto private insurance by providers.

    Incidentally, Medicare and Medicaid services cost double what they did ten years ago.

  • NotAnotherSkippy||

    And he's neglecting to mention that the Medicare population has been trending younger recently because of the boomer retirement wave. That is a temporary help that will turn negative quite quickly.

  • Fuck you, Shikha (Nunya)||

    Who exactly are you shilling for? These "facts" you are bandying about are not those of your standard fare interested party. Speak your alliance or shut the fuck up. Until you come clean you have nothing to offer.

  • ThomasD||

    "and delivers quality care more efficiently than the private sector."

    Utter nonsense.

  • MarkLastname||

    More lies from Chandler. Medicare is popular because consumers don't have to pay for it; it's less efficient than the the private sector though.

    The myth that Medicare is more efficient (has lower administrative costs) is due to not taking into account that Medicare patients are disproportionately sick and old, therefore taking more claims per patient; but administrative costs correlate with number of patients, so by virtue of spending more money per patient (again, they're sicker) a higher fraction of money is spent on medical services.

    The myth is also partly due to failure to account for the fact that private insurers spend money on things like reinvesting money collected from premiums, minimizing frivolous claims, and subsidizing preventive healthcare, all of which are classed as 'administrative' and Medicare either doesn't do or has less of an incentive to do.

    This tired, moronic comparison of spuriously defined 'administrative costs' between a government entitlement program and private insurers is one of those things that immediately gives away that you have no idea what you're talking about.

  • TrickyVic (old school)||

    ""delivers quality care more efficiently than the private sector."'

    That's kinda funny. Private sector doctors provide the services which Medicare pays. Insurances do not provide any medical services, they just pay for them.

  • Last of the Shitlords||

    "I'm referring to the fact that Medicare is extremely popular and delivers quality care more efficiently than the private sector."

    Popular? It's MANDATORY. There really is no comparison to anything, as Medicare is essentially a government monopoly.

  • ThomasD||

    "Put simply, ever capitalistic mechanism that usually works to keep prices down is much much weaker when it comes to medical care then for other services."

    This.

    A male to female trans surgery can be had (yes, at a reputable medical center) for under $25 grand. Which is a lot of money, but when you consider that it includes multiple specialty procedures, from urology to plastics, is insanely cheap when compared to what an 'insured' person might pay for an appendectomy.

  • Fuck you, Shikha (Nunya)||

    Either way I would be losing a useless, dangling mass of tissue.

  • NashTiger||

    Imagine how much Car Insurance would cost if it covered oil changes and new wiper blades and tires.

    Now imagine how much oil changes, wiper blades, and tires would cost if Insurance was paying

  • Don't look at me.||

    +1

  • ThomasD||

    Even worse, imaging if wage and price controls led to multiple decades of employers heavily funding that sort of auto "insurance" via employer deductible expenses.

  • Happy Chandler||

    Many cars come included or for additional charge a service plan which covers those services.

    It may reduce premiums because fewer people out there would be driving on bald tires and bad wipers and crash less.

    If the insurance company had a mass purchase plan, or had their own shops that performed the services, it would cost less than retail.

    You make a good argument, just not for what you think you do.

  • NashTiger||

    lol

    no

    LOL

    Also, EVERY study has concluded that the anticipated savings from preventative care do not materialize, because a) overutilization is more expensive than underutilization b) false positives lead to more tests c) many people had survived years and even decades with small non-aggressive cancers that went undetected, and sometimes even spontaneously disappeared, but are always aggressively and expensively treated when detected by mammograms and PSAs.

    How many accident are caused by bald tires and faulty wipers? Whatever that number is, it would be dwarfed by the cost of replacing everyone's at the recommended wear levels

  • Red Rocks White Privilege||

    Many cars come included or for additional charge a service plan which covers those services.
    It may reduce premiums because fewer people out there would be driving on bald tires and bad wipers and crash less.

    Hey dummy, your premiums aren't reduced until the car is paid off, irrespective of whether you get the Platinum repair plan or not--until that happens, insurance companies require you to carry full insurance.

    Source: someone who's taken out loans on cars for nearly 25 years and gotten top of the line service plans on two of them.

  • loveconstitution1789||

    Chanandler bong has zero what he is talking about.

  • Fuck you, Shikha (Nunya)||

    This is utterly ridiculous, you fucking shill.

    With little exception those are only luxury vehicles that come with such a plan. So that doesn't apply to the masses.

    Your assumption that the person irresponsible enough to drive with poor tires or blades will make the extra effort to schedule time with a provider is a huge stretch. It's like you ignore how people get where they are by inaction, including their inability to be responsible drivers while being irresponsible with their maintenance.

    So your argument is that with medical insurance being privatized is that it adds administrative overhead which when eliminated provides utopian medical services for all. However, you are bereft of the foresight to see it would add cost to all cars of added.

    Do you know why I stopped using all "professional" car care services? Because I can do it at price parity, with better materials, and I know that it will be done correct. Maybe you believe that overpaying, and doubling down on that aspect, along with poor results is a great idea. I prefer to extend my dollar and results by making my own decisions. The same applies with medical services. If I need an engine swap I'll go with with the big guys and use warranty service. Replacing spark plugs, I'll do it myself and save the hassle of the dealership.

  • MarkLastname||

    Every statement you made here is false. It's truky a remarkable feat.

    We really ought to require people to buy food insurance too. Fewer people will go to work hungry, productivity would increase. Boon for everyone!

  • Earth Skeptic||

    Right, what the fuck could go wrong if the "buyer" for the quantity and vendor of the service is nowhere connected to the entity that pays the bills. In fact, some might even be tempted to buy as much as possible, even beyond what they can justify medically.

  • Cloudbuster||

    Of course, under single payer, you're neither the buyer nor the payer. You're the equivalent of a child in government care. You'll take what healthcare you're given, and government will decide what and how much care you get. One day they'll tell you you're too expensive and put you on a nice hospice plan.

  • Bill||

    Moving it all to the federal level is adding several tiers to it, so
    it would then be 4th and 5th party payers. Just like the federal
    contracts after Katrina for cleanup. The people at the bottom
    were paid well but not outrageously but each contractor at
    the levels going up to FEMA got their cut and the whole
    price tag was through the roof.

  • TJM||

    Right? The provision of care, which is really what we are talking about when we mention "healthcare", has been grossly perverted by government intrusion into what is a market system.

  • loveconstitution1789||

    Catastrophic insurance for major medical stuff. People paying cash for everything else would bring medical costs down by magnitudes.

    Doctor: "Want a CAT scan to see if your hair is growing correctly"?
    Patient: "How much does it cost because I need to pay cash"?
    Doctor: "About $2,000".
    Patient: "No fucking way".

  • Happy Chandler||

    Experiences with high deductible plans don't show them to be effective. They are just as likely to reduce required care as non-required.

  • Freddy the Jerk||

    Cite please.

  • NashTiger||

    Out of his ass

  • loveconstitution1789||

    He wont cite because hes full of shit.

  • Rossami||

    If a patient declines the care, doesn't that mean be definition that it was "non-required"?

    Or are you substituting your judgement about "required" for the patient's? Do you also substitute your judgement for the consumer's about food costs or rent?

  • ThomasD||

    Oh shit, don't give them ideas.

  • DrZ||

    "Experiences with high deductible plans don't show them to be effective. They are just as likely to reduce required care as non-required."

    If you are referring to high deductibles in our current system, then you are stating nothing. Our current system is broke for so many reasons and high deductibles are a part of the solution, but in themselves are not the solution.

    First dollar needs to come from the consumer's pocket. Much of a person's medical expenses need to come out of pocket. There needs to be price transparency. After these are put into place then a true catastrophic insurance makes sense.

  • Fairbanks||

    It depends on what you consider "required care." I've had a high-deductible plan since I retired 9 years ago. When I came off my employer's plan I immediately stopped getting some treatments because they were no longer worth it, such as chiropractic for my back and shots for my arthritic knees. I then took better care of my back and knees, so I have less pain than before.

  • loveconstitution1789||

    People take cheaper care of themselves when the medical money comes from their wallet.

    Or they dont.

    Either way, taxpayers save a bundle.

    Plus, if medicare/medicaid was ended everyone could keep that payroll tax each payday.

  • MarkLastname||

    Meanwhile, being on Medicaid has been shown to have no observable positive impact on one's health.

  • Juice||

    just covering the costs with tax money isn't making it cheaper in any real sense.

    It would actually make them shoot up even more, like college tuition, unless some kind of rationing system were in place. I guess Medicare rations as it is, because it doesn't cover 100% of costs. That's why you have to have supplemental insurance. So you'd have Medicare for all, then private supplemental insurance, where the rates would quickly climb to the near the insurance rates we have now.

  • Nardz||

    I feel like $32m is still lowballing it

  • Nardz||

    Whoops, that should read $32 trillion

  • Rhywun||

    I would double that at the very least.

  • BestUsedCarSales||

    Once government gets at it, it will be as high as anyone could ever hope.

  • miketol||

    Maybe the best way to predict these things is to look into the past.

    When Medicare was passed in 1965; the cost estimate for 1990 was 9 billion per year. The actual cost of Medicare for the year of 1990 was 67 billion.

  • loveconstitution1789||

    If Socialists are trying to get something passed in Congress, then double it and add America's destruction.

  • DrZ||

    I like $32m better - it's cheaper.

  • TJM||

    It is always more than anyone could predict when the inefficiency of government's hand gets involved.

  • Rossami||

    Per the article, the $32 T assumes, despite all experience to the contrary, that "provider payment rates [will be] reduced by over 40 percent".

  • Cloudbuster||

    Hahahaha!

  • MasterThief||

    I really think that single payer has no chance at reducing costs unless every aspect of healthcare is controlled in a top-down manner. Almost all care providers would necessarily be forced to work within this system. Costs of drugs, materials, and labor would be tightly regulated. Further, the government would then institute more control over individual choices that may have adverse health effects. Single payer is an aggressive government action to completely own and operate an entire industry while severely limiting the freedom of the population. I'm gonna give a hard pass even before we get into the economics of it.

  • albo||

    Health care rationing will kill single payer in America. We won't stand for it. Couple media stories on dead babies because the NICU was full and the people will march on DC

  • TrickyVic (old school)||

    I think there's a lot about socialized medicine Americans won't stand for. We want our cake and eat it too. We want champagne at beer prices. We don't want to wait a month for a visit.

  • albo||

    Medicare reimburses our township ambulance company about 50 percent of our normal charge, and we can't balance bill the patient for the rest. So we cover our costs through people with private insurance, a local tax, and a subscription plan so that we have a crew at the station on call 24/7.

    With Medicare for all, we'd have ask the township to jack up the tax. Or go to nobody on call and a pager system. I'm sure a heart patient will love that response time of 5 minutes going to 20 minutes or more.

  • loveconstitution1789||

    The law could be changed to bill the patient directly for the entire ambulance ride.

    911 operators ask if you want to pay $1000 for an ambulance ride.

  • BYODB||

    Medicare and Medicaid are usually loss situations for a provider. It's less true for Medicare, but it's almost always the case for Medicaid.

    What's really being sold here is only called 'Medicare for all' because everyone recognizes that the truth of 'Medicaid for everyone' is much, much worse but make no mistake that is what is being sold.

  • Happy Chandler||

    Or you could try to be more efficient.

  • Freddy the Jerk||

    Riiiight. 'cause nothing goes together quite like "government" and "efficient".

  • Nardz||

    Progressives (like HC) have a different connotation of "efficient" than the rest of us.

  • Happy Chandler||

    I was thinking along the lines of reducing expenses to make more profit. What were you thinking of?

  • TrickyVic (old school)||

    ""I was thinking along the lines of reducing expenses to make more profit. What were you thinking of?""

    What lines are you thinking of reducing?

    Technology is one of the driving costs.

  • Happy Chandler||

    Uhhh, he's talking about an ambulance company. To me, that implies a private company.

  • TrickyVic (old school)||

    ""Or you could try to be more efficient.""

    Like the VA?

  • loveconstitution1789||

    As a veterans under VA care, you dont want Government medical to do shit for you.

    Imagine politicians running your clinic and bossing your doctors around.

    Its why numerous old betetrans died waiting for surgeries.

  • loveconstitution1789||

    Old veterans*

  • Bill||

    Veterans who like to gamble = beterans, good one!

  • MarkLastname||

    Or the government could stop imposing price controls that cause inefficiency.

  • NashTiger||

    And there are individuals who use ambulance service like Uber. Get a ride across town when you are out on your drug-seeking weekender. It is illegal to deny them service

  • Get To Da Chippah||

    Or one or two Charlie Gard cases in America would have people firing up killdozers in no time.

  • Billy Bones||

    We are currently in this mess because of the socialism already involved in health care. Insurance is a socialistic endeavor (the healthy people who make good life choices subsidize the costs of those who do not make good choices). We are not going to fix it with more socialism...period!

  • Skyhawk||

    What makes it much worse is the importation of millions of unskilled poor and the 50+-year government program enabling and subsidizing unchecked breeding of domestic poor.

  • Nardz||

    I used to work with a Medicaid contractor arranging services for people in GA from Macon south. Can't tell you how many times I'd schedule children, mother, and grandmother at the same time. I'd say 80% were families that had been on medicaid for generations.
    LBJ's plan working perfectly

  • loveconstitution1789||

    Slavery without the chains. Serfdom.

  • Rossami||

    Not exactly. Socialism is government control of the means of production. Health insurance (which is not really insurance) has some of the conflicts of interest and negative externalities of socialism but it arrives at them through a different path.

    Single-payor, on the other hand, would be a direct step toward government control of the means of production across the entire health care industry.

  • EscherEnigma||

    Nah. We were all assured that the ACA was a "socialist takeover of healthcare".

  • NotAnotherSkippy||

    Funny, I thought it was supposed to bend the cost curve down, save families $2500, AND let you keep your doctor.

    Didn't it?

  • MarkLastname||

    It was a big step in that direction.

  • Cloudbuster||

    The ACA is more properly described as Fascism than Socialism: Private companies still exist, but they are heavily regulated by the government.

  • ||

    The difference being insurance is completely and absolutely voluntary. It's as voluntary as paying into a 50/50 raffle draw at Yanks game.

  • Bearded Spock||

    Not even their public opposition to Trump can save the Koch Bros from being lumped in with the Hoarders and Wreckers.

  • OpenBordersLiberal-tarian||

    Instead of responding to the details of the Mercatus analysis, Sanders attacked the think tank's connections to the Koch Brothers.

    People often ask me what the difference is between a left-libertarian and a progressive. This is a perfect illustration. Left-libertarians like me are big fans of the Koch Brothers because they devote some of their tens of billions of dollars to funding open borders advocacy. We would never argue that a policy is incorrect simply because the Kochs are behind it.

    I like a lot of what he stands for, but Bernie is wrong here.

  • Holmes IV||

    What does he stand for that you like?

    You call your self left-libertarian and he is a self-described socialist. I'm interested to hear what you and he have in common (and don't go the guns 2A route, that is boring and you know it.)

  • Palin's Buttplug||

    OBL is a parody account.

  • Holmes IV||

    People say the same thing about you, Homie McHomechicken. And anyway, from what I have seen OBL has never gone the full nut-job you do on a regular basis. So unless it is YOUR parody account (which would be an odd choice...) don't speak for others.

    Everyone knows you are a fascist and know what is best for everyone, but how about you either add something helpful (or at least funny) to the conversation, or just sit the eff down.

  • Palin's Buttplug||

    Fuck you, asshole. I thought you didn't know.

    For the record I think Bernie Sanders is senile and stupid and Single Payer is a reflection of his condition. If that makes me a nut-job I don't care.

    This is nothing new. When he lost the 2016 primary he floated a Single Payer plan that had trillion dollar math errors in it.

  • Holmes IV||

    youmadbro.jpg

    I'm actually happy to hear hat you think Sanders is nuts. I don't think you will get many opponents here, but you already knew that.

  • Nardz||

    Eh, he's with Her

  • loveconstitution1789||

    Colonel Sanders stole the election from Hillary too.

    It was the Ruskies and that damn feel the Bern campaign!

  • TrickyVic (old school)||

    ""Colonel Sanders stole the election...""

    Which one? Norm McDonald?

  • perlchpr||

    Ha ha, OBL really is a parody, but this is hilarious. :D

  • OpenBordersLiberal-tarian||

    What does he stand for that you like?

    From a libertarian perspective, Bernie Sanders' best political position is his belief that abortion should have no legal restrictions whatsoever, even in the third trimester.

  • Benitacanova||

    The only way to really reign in costs is to force all med workers to become govt workers and watch their salaries get reduced by 80%. I'm sure that would go over big.

  • juris imprudent||

    Only the pure of spirit go into medicine to serve their fellow kind, the rest are kulaks and wreckers and must be purged.

  • BYODB||

    Amusingly, this is why in a socialist utopia they hand out a bunch of degree's and credentials to people who haven't earned them and aren't really 'doctor's'.

    It's because the real one's either fled or were shot.

    Whoops. Didn't work then, won't work now. In fact, it will never work.

  • loveconstitution1789||

    If everyone pays cash for medical services, they would be more picky to keep costs down.

  • SimpleRules||

    Agree. If you *must* get the govt involved, provide for tax-deductible HSAs. Medicaid would be replaced by a deposit into an HSA so it's still up to the individual to make good decisions. Yes, there's still ample opportunity for fraud, but also the incentive to spend efficiently.

  • Happy Chandler||

    How much do you think you can bargain down a round of chemo treatment? Or maybe you decide it's not necessary.

  • Don't look at me.||

    It's usually a waste of time. You got the big C, you gonna die.

  • Happy Chandler||

    My dad has been over five years with Pancreatic Cancer, thanks to a lot of money first from his private insurance now from Medicare. Care has been provided through UCLA Medical Center, run by the state of Commie-fornia.

    Glad he wasn't presented a cash bill, or you're right, he'd be dead.

  • BYODB||

    Five years with pancreatic cancer? That's sort of a surprise since it's almost always fatal within a few months and you dad appears to have outlived virtually everyone else ever diagnosed with it. Even if it's true that he's lived that long with it, it's an extreme outlier (and, to be clear, I do not believe you.)

  • Happy Chandler||

    He was diagnosed in stage 2 (very lucky, for sure!) and had a Whipple.

    http://pancreatica.org/pancrea.....prognosis/

    The prognosis for those who are able to have surgery is improved over those who are not able. Unfortunately, only about 15% of those individuals with pancreatic cancer will be found to be eligible for surgery – for most, the cancer will have been found to be too advanced. For example, patients with pancreatic cancer who received the Whipple surgical procedure in one study (from a very experienced Johns Hopkins team) were reported as having a 21% five-year survival rate, with a median survival of 15.5 months. In more recent studies this five-year median survival duration after surgery has been reported as high as twenty months.

    5 year survival rate is 21%. He's lucky and has incredible care from his state run, socialist health care.

  • ||

    You're being a little disingenuous in describing UCLA Medical Center as "state run, socialist health care."

    Yes it's associated with a public university system, but it's hardly some kind of county hospital.

  • NotAnotherSkippy||

    Well all of those chemo drugs were government funded anyway. At least that's the little chestnut that the 3 musketeers of economic ignorance like to falsely trot out.

  • Bill||

    Glad your Dad was able to get the Whipple. My best friend's father-in-law looked like he was a candidate for the Whipple but during the first hour of the surgery, they found it had
    spread, so they stopped the procedure and sewed him back up.

    I see JoeBlow's point down below, but more importantly, people with things like Pancreatic cancer are doomed if they have to wait a month or two to get an appointment. Government health care around the world has shown to increase wait times to see the doctor as well as wait times for "non-critical" surgeries like hip replacements. My wife had an unusual case where her hip socket started to deteriorate quickly over 12-20 months. She has a high pain tolerance so did not complain until it was already really bad. First doctors she saw treated it like an ordinary case with someone with new symptoms and so she got routine meds and pain treatment, none of which worked. After a few months she saw a specialist (due to waiting to see if the first treatments worked) and they saw right away that her hip was really bad and told her she needed an immediate hip replacement which she got a few weeks later. In Canada and UK, she would have had to wait months longer in severe pain to get it replaced.

  • Bill||

    And there is a huge *fracking* difference between Denmark with 6 million people or Canada with 25 million having govt run health are and a huge country like USA with 350 million and 50 different state governments. Any administrative savings in some areas will be swamped by the inefficiencies and extra costs of trying to run a program in 50 states with 350 million people.

  • miketol||

    The government likely could have provided your father's care at much lower cost under a single payer system. After spending 6 months on a waiting list to see an oncologist; his cancer would have probably progressed to stage 4. At that point, he would only need hospice care. Hospice care is much lower in cost than a Whipple procedure, chemotherapy drugs and radiation treatments.

  • JoeBlow123||

    I'll be honest here, what do you think your dads chances of getting this great treatment at UCLA medical center would be if he did not have private insurance and was what I am guessing is a middle class lifestyle and he instead had to compete for treatment and scarce resources with every poor Mexican farming in the Central Valley, every poor hick from way NorCal, and every poor inner city goober?

    I would guess less great. I imagine some sort of luck lottery unless you connected or super rich.

  • MarkLastname||

    How much do you bargain down the price of any good you ever shop for, including necessities of life?

    Socialist doesn't know how markets work, news at 11.

  • Red Rocks White Privilege||

    How much do you think you can bargain down a round of chemo treatment?

    Single-payer supporters always cite treatments on the margins rather than normal preventative healthcare measures.

  • Happy Chandler||

    Canada's costs are much less than ours and outcomes are better. Their doctors are not government employees.

  • Rossami||

    Living in Cleveland, I know a number of people with family across the border. Oddly, none of them agree with your assessment that "outcomes are better". They do agree that "Canada's costs are less" but that's offset by the need to come to the US for treatments that either can't be gotten at all or can't be gotten in time in Canada.

  • LynchPin1477||

    I lived in Canada for 3 years and didn't have to interact with the healthcare system that much, since I'm pretty healthy. But my experiences when I got sick were something like the following:

    1) Get up early enough to get a place near the front of the line at the clinic.
    2) Wait a few hours to see a Dr anyway
    3) See a series of nurses, then spend maybe 5 minutes with a Dr that didn't seem particularly happy to see me
    4) Get what I needed with no out of pocket expense

    It wasn't horrific by any means. But there were definitely trade-offs for that no-out-of-pocket-expense. And there was (presumably still is) a Dr shortage in Quebec.

    My two cents.

  • Happy Chandler||

    Same day appointments are a weak spot in Canada compared to European countries. The US is a little better, but the Europeans are still better than us on it.

    But, the health outcomes are better for Canadians. Life expectancy, infant mortality, maternal mortality, are all better in Canada.

    There is no movement to eliminate Medicare in the US in exchange for private insurance. Why? Socialist medicine works and is popular. When they tried to use private insurers to compete with traditional Medicare, they had to pay them more money than Medicare spent so they could compete.

  • Red Rocks White Privilege||

    There is no movement to eliminate Medicare in the US in exchange for private insurance. Why? Socialist medicine works and is popular. When they tried to use private insurers to compete with traditional Medicare, they had to pay them more money than Medicare spent so they could compete.

    That's because Medicare underpays on provider costs.

  • NotAnotherSkippy||

    Health outcomes are better if you don't control for population differences, turf out all of your difficult medical cases to the US (Seattle'd, Mayo'd, Buffalo'd, Boston'd). 5 year survival rates for major cancers and heart disease are significantly higher in the US than in Canada. So other than being completely wrong, you got it right.

  • Fuck you, Shikha (Nunya)||

    How do the illegal immigrants figure into their numbers? Oh, right. Zero.

  • MarkLastname||

    Outcomes and quality of care are not the same. The US has better quality care for cancer and cardiovascular disease if one controls for confounded than canada, and those are the two biggest. Our general outcomes are worse because of car crashes, drugs, smoking, drinking, homicide, etc.

    The main reason American healthcare is so much more expensive than everywhere else is because the volume consumed is so much higher.

  • ThomasD||

    "govt worker" is a very Orwellian name for what you describe.

  • sarcasmic||

    Economic arguments against government health care will fall on deaf ears, because for the proponents it is a moral issue. For them it is simply immoral to profit off of the sick and dying. Because government doesn't profit, it is the only moral administrator of health care. So what if it cost more? So what if it leads to rationing? So what if people get inferior care? So what if medical science comes to a standstill because there is no incentive to come up with new things? It's better than rich people making immoral profits.

  • Red Rocks White Privilege||

    The stupid think about the "immorality of for-profit healthcare" argument is that "non-profit" hospitals are just as expensive as the for-profit ones.

    The issue with healthcare costs are systemic and can be tied to the lack of cost transparency within the industry, monopolistic behaviors in the form of price-fixing between providers and insurance companies, and providers shifting the unmet costs of Medicare/Medicaid and emergency room treatment onto the backs of private insurance holders. This is one area where simple enforcement of *existing* laws and a mandate for price transparency would go a long way towards curbing and even lowering the 8% annual increase in healthcare costs, but no one has the guts to actually implement it because it would mean the instant elimination of government insurance programs to make it happen. Trump actually had reasonable proposals for healthcare during the campaign (they were so good that the liberals' main objection to it was, "the Republicans will never go along with it!"), but he's never pressed it since.

  • Nardz||

    "The stupid think about the "immorality of for-profit healthcare" argument is that "non-profit" hospitals are just as expensive as the for-profit ones."

    Ironically, non-profit hospitals have a higher profit margin than for profit hospitals
    About 12% to 8% - industry average
    And to maintain non-profit status? Something like 25% of services must be pro bono - but things like conventions and fundraisers count toward that 25%, so it's not actually pro bono care in many cases

  • JFree||

    Maintaining that non-profit status is not done thru pro-bono stuff at all.

    It is done by plowing profits into marginal under-utilized and expensive capital equipment. Which then results in pressure to overdiagnose, massively jacks up fixed overhead costs which is spread out over all patients, and excessive and expensive treatment (eg using proton beam therapy to treat prostate cancer expensively rather than its actual medical benefit of brain/spinal cancers).

  • BYODB||

    'Thru' instead of through should only be used if you're, say, a McDonald's drive through sign maker. Anywhere else, it makes the writer look like a child, a moron, or possibly both.

    I mean, this is just an internet comment and you can write however you want but just know it makes you look like a tween girl and it seriously impacts any sentence you put it in.

  • JFree||

    So you gotta problem with McDonalds drive THRU sign makers?

  • BYODB||

    Not at all, it's appropriate for signs that physically have a difficult time displaying, say, 7 letters instead of 4.

  • JFree||

    Yeah well I'm a long-winded gasbag so I save letters when I can

  • Bill||

    I like to save time and effort and I use "thru", "hi" and "lo" and a few others whenever the fuck I want for informal communication. Especially texts or if I were ever to us Twitter (not likely).

  • NashTiger||

    Government workers profit. They make more than Private sector workers of similar credential

  • TrickyVic (old school)||

    ""Supporters of single-payer will have to convince Americans that it is worth paying twice (or more) as much in taxes in order to get "free" health care (and abolish premiums, co-pays, and deductibles).

    Progressives seem prepared to make that sales pitch"""

    It's one I don't think people are interested in hearing either. Raising taxes have been pretty much a deal breaker. Bush Sr. didn't get re-elected after violating his no new taxes pledge.

  • Nardz||

    Haven't you heard?
    #bluewave is being propelled by the platform of no border control and Pelosi's promise to raise taxes

  • albo||

    And surfing that blue wave is the Democratic Party's charismatic new leader, a socialist bartender from Brooklyn. So much winning

  • TrickyVic (old school)||

    We'll see how much winning if/when she gets to DC. She will be a freshman congressperson. She will be so disappointed she can't get the seniors to do what she wants.

  • Hidebehindyourcause||

    Some supporters of team blue only hear "the rich will have to pay more".

    I really think some have no idea that gubmint will fuck everyone over equally by taking more money out of everyone's check

  • Happy Chandler||

    Clinton and Obama both raised taxes and were reelected.

  • BYODB||

    The question is do you see a Democrat being elected on a promise of 50-75% of your income going to taxes?

    Survey says no.

  • TrickyVic (old school)||

    I totally believe some leftist would be fine with it being said. Once it hit their pay checks they will blame the republicans.

  • Happy Chandler||

    I think most people won't really care whether the deductions on their paycheck go towards taxes or to medical premiums. Since the total spending would be lower, the final paycheck would be higher for the average person.
    Getting every business out of the health insurance business would also be a boon. HR departments could be cut in half, because they wouldn't need as many benefits administrators. People's paychecks wouldn't be as stagnant, as more and more of their pay goes to their insurance premiums.

    The biggest problem I have with Obamacare is that it kept the employer based model. That needs to be phased out eventually. I've had to change doctors because I got a new job. What's the deal with that? Because, in WWII, health insurance benefits didn't count as wages, so that's how companies got around wage controls.

  • BYODB||

    Deflection, the fact is that even Democrats would have a tough time selling a doubling of taxation to their base. Note that when presented with an opportunity to do something like 'Medicare for All' Democrats opted to do something else.

  • Happy Chandler||

    Republicans have no problem spending money and cutting taxes.
    Promise that M4A will pay for itself through efficiency.
    Cut taxes.
    Everyone wins!

  • BYODB||

    More deflection, I see. Note I didn't say Republicans are good, I said Democrats have nothing of substance. This plan, for example, which lacks the ability to actually survive contact with reality.

  • Hidebehindyourcause||

    HC, why are you bringing up Republicans when he's talking about your fellow Democrats?

    I guess it's a natural prog reaction when overlords get criticized

  • BYODB||

    Oh, and this is especially amusing:

    Because, in WWII, health insurance benefits didn't count as wages, so that's how companies got around wage controls.

    What you fail to see is that this is one incredibly large patch of 'band aids' the government has been constantly putting on 'healthcare' for 100 years, and no amount of government tweaks are going to fix it. The evidence for that? 100 years of band aids that did not fix the problem, and instead have made it worse.

    In fact, the ACA is recognized to make the problems worse but like all of the band aids in the past it makes us feel moral now even though we know it will fuck people tomorrow.

  • Bill||

    That's correct. And the reason there were wage controls is because FDR put them in place under the wrong headed notion that it would fight inflation (it doesn't). Even more ironic is that it turns out that during the depression, there was actually severe deflation and the govt was fighting the opposite problem it thought it was. FDR was an authoritarian lame-brain who tried to pack the supreme court when he couldn't get his way and instituted many of the planks of the Socialist Worker's Party in his efforts to fight the depression. Congress and the president also passed the Smoot-Hawley tariffs at this time and caused a world-wide trade war that exacerbated the depression and made it last much longer. This also created the economic conditions that Hitler and Mussolini were able to use to come to power.

  • JFree||

    Single-payer health care may very well be an improvement on some aspects of the current American health insurance system, which is a weird mish-mash of overlapping programs, subsidies, mandates, and highly regulated markets that often makes little coherent sense. At the very least, a debate over a robust overhaul of the system is badly needed.

    Yeah that sort of debate is badly needed and overdue - but what is now obvious is that that debate isn't gonna happen until 'the system' is a government program and the debate can take place within a completely partisan environment of focusing on 'reforming' an existing govt program.

    GOP had 8 years to devise a nongummint alternative to Obamacare (re only the uninsured or uninsurable) - 25 years to sell/devise the nongummint alternative to the last 'comprehensive' reform of 1993 (when healthcare consumed 12% of GDP). The result - bupkis. They got nothing.

    Now the Dems get to play their hole card and see what the result is.

    I'm not optimistic about either party.

  • juris imprudent||

    Why would the GOP truly want a non-govt solution? Seriously, where are the votes in that? Sure you might make the libertarian splinter of the electorate happy, but are you going to premise office holding on that?

  • JFree||

    That's why we're gonna end up with a government/Dem solution here. They got their Medicare for All catchphrase now - and it polls well- and GOP now owns medical inflation/access.

    Might not happen for 2018 - since GOP/Trump has managed to elevate 'illegals' to main issue/worry status and the economy is doing well. But this biz cycle is long in the tooth - and any crack that produces layoffs will jack up worries about losing medical coverage too.

  • TrickyVic (old school)||

    ""They got their Medicare for All catchphrase now""

    Every time I hear someone say that I ask why Medicare? It doesn't cover preventative services and only covers 80% of the bill.

  • Bill||

    I'm going to steal that!

  • TrickyVic (old school)||

    Take it!

    It's insurance so good that you need to buy more insurance so you're not stuck with a bill.

  • Sebastian Cremmington||

    Ryancare accidentally spent more than Obamacare and Democrats were stupid not to quickly pass it. During the Ryancare debate is when everyone figured out the CBO scored the individual mandate as a "cost" which is why Ryan sheepishly shelved it and then repealed the individual mandate in the tax bill. Now we don't have that $300 billion for subsidies because Democrats are so stupid!

  • chipper me timbers||

    What is the price tag on all the freedom that it will cost me?

  • Tony||

    Stop defining freedom only as not being taxed. You know what's a real drain on freedom? Cancer. Also money.

  • Hidebehindyourcause||

    You know what else is a real drain on freedom? People that don't pay their debts

  • Fuck you, Shikha (Nunya)||

    Leave it to Tony to not associate a massive, greatest ever to be more precise, increase in tax burden to not have an impact on freedom. Ignore the fact the entire purpose is to eliminate choice. Ignore the number of folks that will lose their jobs because decided better for them. Ignore those that don't want or need government insurance or private insurance.

    Yep. Totally not about freedom.

  • MarkLastname||

    So we ought to call bank robbers 'self-freedom enhancers?'

  • albo||

    Always ignored in this debate is rationing of care. If you have government single payer, you're going to have a medical budget. Costs of care will have to fit into that budget. There will be waiting lists. You'll have to wait for weeks or months in pain before you get that knee MRI. Some people will die on the waiting list. Americans aren't used to that happening. They'll go nuts.

  • TrickyVic (old school)||

    Medical care options for the elderly go down too. You can't give a 77 year old a new heart when there are a bunch of younger folk waiting.

  • albo||

    "Time to take one for the team, Granny."

  • NashTiger||

    77yo olds don't get new hearts now. It would help if you knew what you were talking about

  • swampwiz||

    Didn't that nonagenarian Rockefeller get a new heart? (Actually a few AIR).

  • BYODB||

    Dick Cheney got one at 71, doofus.

  • NashTiger||

    EXACTLY, because the natural life expectancy of a healthy person at his age exceed the average lifespan of a heart transplant patient, which is 9 years.
    People who actuarily will not live longer than the average transplant patient go to the back of the line, and only get an organ if there are no other younger healthier matches available

  • JFree||

    Always ignored in this debate is rationing of care.

    You have rationing of care in ANY medical system and at all times in that system.

    Only question is - what is the basis of that rationing? Is it price? Is it pre-existing access? Is it some decision by 'experts' or 'insurers' or somesuch?

    In the US, because our medical system is based mostly around employment - the answer to which rationing system we prefer varies with where we are in the economic cycle and how secure jobs are.

  • BYODB||

    Duh, McFly, we generally call central system care rationing bodies 'death panels' since they decide who lives and who dies.

    That is how every centralized medical system makes those determinations. That is how an American system would make those determinations.

    The people who live through the system will probably sort of approve since ultimately they got theirs, but those who do not will not be available for comment on how much they enjoyed their service. Just like the NHS.

  • Gilbert Martin||

    "Only question is - what is the basis of that rationing? Is it price? "

    Nope - price has nothing to do with actual rationing.

    It's only rationing when government force is involved.

    If one person is rich enough to afford a steak dinner at Morton's and another person is not, that doesn't mean the former was "rationed" a fancy steak dinner.

  • JFree||

    If one person is rich enough to afford a steak dinner at Morton's and another person is not, that doesn't mean the former was "rationed" a fancy steak dinner.

    If one person is rich enough to go to the doctor regularly and get treated for anything as needed, they have an avg life expectancy of roughly 88 (my proxy - top two income quintiles).

    If one person can't afford to see the doctor much and can't afford the deductibles for treatment, they have an avg life expectancy of roughly 75 (proxy - bottom two quintiles)

    Unless you are asserting that they WANT to die early; then they ARE being rationed by price.

  • ||

    I'm not sure it's that solid to compare life expectancy for the top two and bottom two quintiles and assume that the gap is explained 100% by access to medical care.

  • JFree||

    I don't really need to account for 100% of 13 YEARS. The medical problems at the lower incomes in the US are VERY obvious - fat, smoking, sedentary, poor nutrition, minor stuff that gets worse over time. All stuff that primary care doctors can tell patients about - and help them put together a plan for changing it - and point out the benefits of changing it.

  • NotAnotherSkippy||

    and help them put together a plan for changing it - and point out the benefits of changing it.

    Which they do and are then promptly ignored. Turns out that making choices in life has consequences. I realize that's hard to hear.

  • JFree||

    Which they do and are then promptly ignored.

    So in six months, they go to the doctor again - and hear the same thing. And again. And again. Not everyone will change. But the only way anyone WILL change is to hear the message - from a friendly knowledgeable person who they trust - over and over and over. At some point, something changes and it often clicks for that person

    Avg PCP visits per year in most countries - 3-5 (except Japan which is prob 10 or so)
    Avg PCP visits per year in the US - less than 1

  • NotAnotherSkippy||

    So those same people who ELECT to only go to the primary once a year are going to suddenly start listening to them.

    Your logic, as always, is irrefutable.

  • JFree||

    I'm gonna guess you work for a big company - that has an employee benefits dept that does all the insurance negotiating (which is btw one of the things I did for those big companies I once worked for) - so you can be blissfully oblivious of all reality and pretend that ideological phrases have all the answers

  • Bill||

    And none of those would be helped by single payer. (fat, smoking, sedentary, etc.)

  • JFree||

    And none of those would be helped by single payer

    No. They would be helped by reform of our mediocre and very expensive system.

    Unfortunately one party thinks the solution is to stick our heads up our asses and chant USAUSAUSA. The other thinks the solution is single payer.

  • BYODB||

    The trick you employ here? Saying that preventative care is expensive. It's not.

    What is expensive is waiting until it's a huge problem before going to the Doctor.

    And study after study after study has shown that people will not spend money to go to the Doctor for preventive care, even though they'll spend much larger amounts of money for things like vehicle maintenance.

    Shocking, I know, that people don't like spending any amount of money on a 'service' that only saves your life but that is a fact in the medical world.

    The point Gilbert made, which is absolutely correct, is that market forces are not 'rationing' since 'rationing' is itself a feature of command and control. We call that 'scarcity' in economics, which just by the way is never even spoken about in American healthcare discussions. Gee, you'd almost think people are idiots and haven't noticed that 250,000 primary care doctors can't service 350 million people over a massive geological area.

  • JFree||

    The trick you employ here? Saying that preventative care is expensive. It's not.

    In the US it is VERY expensive. Because it ain't effectively covered at all by insurance until after one hits their deductibles. And for the lower income, they are a)much less likely to get insurance coverage partially subsidized by an employer and b)if they do, they have to pay a higher premium even for the same coverage and c)even if the prev two are ok, they STILL usually have to pay a higher deductible as well and d)even if the previous three are ok, they STILL end up having to select,if possible, a higher deductible merely to afford the premium because we use a flat-dollar cost approach (rather than say a % of pay approach or something). And all those problems are getting worse not better over time.

    I agree with your underlying point that preventive is dirt cheap. But that ain't how OUR system is designed. And blaming the lower income for the way our system has developed is completely insane.

    And scarcity IS rationing. Tomato tomahto. If you don't like the word rationing, it's because you're uncomfortable with talking about the reality of that.

  • NotAnotherSkippy||

    This is idiotic. The out of pocket expenditures for many European countries is HIGHER than in the US.

  • JFree||

    The out of pocket expenditures for many European countries is HIGHER than in the US.

    Well actually it is comparable in absolute dollars - roughly $500-1000 in various nickel-and-diming type costs. Which is OK if their insurance premiums are dramatically LOWER - which they are - esp at lower income levels in other countries. But if the insurance premium is already squeezing them dry, then the low income will forego the 'extra' costs of uninsured expenses - unless it is an emergency. This isn't some matter of choice. It's because they don't have the fucking money - and unless they DO have the fucking money, they get rationed out in ANY pricing system.

    Yeesh. This isn't rocket science. The whole point of a pricing system is to ration out at the margin.

  • Bill||

    Preventative care can be losing weight, stopping smoking, walking a few miles a day.

    All are very cheap. In fact, eating and drinking less and stopping smoking save money.

  • JFree||

    Oh - and lack of primary care doctors also is a form of rationing. When I moved to Denver many years ago, I didn't have an employer plan so I looked on some doctor registry to see who was accepting new patients. 13 PCP's in the entire city (out of maybe 400+ idk) - 7 directly affiliated with hospitals (which I personally don't like with PCP); 3 Vietnamese in Viettown; 1 64 year old, and 2 others. Called some other practices who weren't on that registry and the waiting list for a 1st appointment for new patient without insurance was up to 3 months.

    If Americans don't believe waiting lists occur in the US; then they work for a big employer who takes care of all that stuff for them so they can choose to be ignorant. I've lived in UK, NL, and CH - in no case did I have to make more than 3 calls to get an appt within a week. They overtly ration specialists. We covertly but directly ration PCPs.

  • Nardz||

    Then Denver must be pretty shitty.
    I didn't have insurance and made an appointment with a new PCP the next day. $50 per visit, I go about 4 times a year - total cost $200, and when I need a rx I call in and pick it up in an hour.
    Weird that you struggled so mightily, being in the industry and, presumably, an adult

  • JFree||

    GP's/100k people by country:

    US - 44
    Thailand - 30
    Poland - 38
    Spain - 75
    UK - 79
    Italy - 88
    Switzerland - 115
    France - 154
    Germany - 175

    Facts are on my side not yours. We ration GP's - the most basic universal doctor - in the US.

  • Gilbert Martin||

    "Oh - and lack of primary care doctors also is a form of rationing."

    Nope - only government force is rationing.

    You will never be capable of proving otherwise.

  • JFree||

    Nope - only government force is rationing. You will never be capable of proving otherwise.

    Fine. You call it allocating scarcity then. I'll call it a tomato.

  • Bill||

    It's not called rationing. That word has a specific meaning. It is called scarcity and the law of supply and demand. However, due to government interference in the health system, some of the scarcity is due to red tape - so that part of it could be called unintentional rationing.

    For example, the government allows the AMA (which smartly merged with the DO's decades ago when they started to provide cheaper health care) to be the sole regulator for licensing medical schools. Just keep the # of med. schools down and make it very difficult to become a doctor and you limit the number of doctors which increases their salaries. So, this is a form of government sanctioned rationing.

  • JFree||

    the government allows the AMA (which smartly merged with the DO's decades ago when they started to provide cheaper health care) to be the sole regulator for licensing medical schools.

    Like it or not, all that medical school/training stuff was done at least 110 years ago with the Flexner Report - and earlier when the AMA started that whole process in motion.

    This is where I have a real problem with many knee-jerk 'libertarian' (though I suspect you're really just a typical R) responses blaming gummint as the root of all evil. In 1910, there was NOTHING that gummint did re health. It didn't do anything for decades after that. It didn't do anything to put the recs in action. In fact, it was two rich guys - Carnegie and Rockefeller - who made that all happen. And the AMA did what all guilds do.

    But somehow now it's gummint that's to blame for everything. This would never have happened without gummint screwing it all up. And the solution to changing anything that might be wrong/outdated is - nothing at all. So - is that system we have working or not? If so, whatcha whining about? If not, what makes you think handing it over to new gen of rich guys is gonna make it work better?

  • perlchpr||

    And both of their life expectancies drop to zero if they stop eating, so what's your point?

  • Gilbert Martin||

    "Unless you are asserting that they WANT to die early; then they ARE being rationed by price."

    What anyone "wants" is irrelevant.

    Someone may want a Rolls Royce. If they cannot afford to buy one they are not being 'rationed" out of it.

    Medical treatment is a a commodity just like any other. And just like any other commodity, if you cannot afford it on your own that doesn't mean you have been "rationed" out of it as there is no government force is involved.

    As I said before, it's not rationing unless government force is involved.

    There is nothing you can say about it that's going to change that fact.

  • jjjjj||

    This is why if I were a GOP legislator in a blue state where they are trying to do single payer on a state level, I would support it. This needs to be a spectacular failure with localized effects before the stars align for it on a national level. Make the state take one for the team.

  • Diane Reynolds (Paul.)||

    Why do I feel like we're getting off cheap here?

  • Palin's Buttplug||

    "Deficits Don't Matter" - Dick Cheney, Donald Trump, George W. Bush

  • Fuck you, Shikha (Nunya)||

    Congrats. You hate them too. Point?

  • Cy||

    After all of the means for production are seized we'll have plenty of money to pay for it. After all, rich people can afford it.

  • LynchPin1477||

    Sanders' Medicare-for-all plan would add $27 billion to the federal budget deficit over the first decade

    I assume that should be trillion?

  • Rebel Scum||

    Something something other peoples money.

  • Rockabilly||

    Hey man, like why can't the goober mint like buy some paper and inks at Costco and print the $32 trillion?

    Paper and inks can't cost that much wholesale and the peoples will rejoice.

  • Sebastian Cremmington||

    Obviously single payer is the most logical health care system but the reason I would never support it is because Republicans are so irresponsible they would repeal the health care taxes once they returned to power. So counterintuitively single payer would be a huge windfall for the well off.

  • albo||

    single payer is the most logical health care system

    You should put some ointment on that begging the question.

  • Sebastian Cremmington||

    The only reason we have a functional private market is because the UAW and New Deal Democrats created the most business friendly market in history which is the group market. Only an old Hubert Humphrey Democrat stuck in a time warp could defend the group market as a logical market. Ironically without the group market we would have universal single payer!

  • Gilbert Martin||

    Another parody account I take it.

  • Sebastian Cremmington||

    Wow you are dumb...

  • Migrant Log Chipper||

    He's a DU refugee moronic troll, that's all he's got......

  • Sebastian Cremmington||

    How precious—you are so dumb you don't realize you have been defending a system created by the UAW and New Deal Democrats!! I bet you were the guy that created the sign—"keep the government out of my Medicare!"

    Deplorables are so f'ing stupid.

  • Red Rocks White Privilege||

    How precious—you are so dumb you don't realize you have been defending a system created by the UAW and New Deal Democrats!!

    Funny how that system didn't start falling to pieces until Medicare and Medicaid passed. You used to be able to have a normal live birth and two days in a private hospital room for about $1,000, inflation-adjusted. Now that costs about $25,000, with $10,000 of that being for the birth procedure itself. Those systems cause providers to shift the costs of services onto private insurance holders like myself, and have done jack and shit to prevent exponential price increases.

    You progressive shitheads took a system where you could pay cash for most procedures, and ruined it to the point that we now have an 8 percent annual increase in the cost of healthcare. You're not interested in enforcing existing laws that forbid price-fixing nor mandating price transparency, which would effectively prevent most of the price increase abuses that we're seeing. Your only demand is a government insurance plan. That's literally all you have.

    You commie fucks all need to be beaten to death.

  • Sebastian Cremmington||

    Look in the mirror—you are the Democrat fuck! Quite frankly it isn't surprising because you also support Confederate memorials to racist Democrats funded and erected by racist Democrats!!

  • TrickyVic (old school)||

    ""Obviously single payer is the most logical health care system""

    Then you would agree that having death panels to reject older patients care so younger people can have care is logical.

  • Happy Chandler||

    We already have Medicare for the elderly.
    Socialism works for the ones who need the most care.

  • Get To Da Chippah||

    Make sure you tell that to any veteran who's waiting months for a VA appointment.

  • TrickyVic (old school)||

    It will go away for the elderly because the young people need it the most.

  • NashTiger||

    Yes, which is why my mother, while waiting months for an approval for a simple epidural pain block, too so many otc NSAIDS she developed a duodenal ulcer which nearly killed her, and led to Medicare spending $300K on the ICU instead of $3K tops for a year of relief

  • Sevo||

    Happy Chandler|7.30.18 @ 4:36PM|#
    "We already have Medicare for the elderly.
    Socialism works for the ones who need the most care."

    Yep, if you can find a doctor who accepts it as full payment.
    You really are that stupid, aren't you?

  • BowserB1946||

    But someone going on Medicare now, has been paying for it for 45 or 50 years, plus his employer has been paying a similar amount. Where do you get the money for the Socialized medical care?

  • MarkLastname||

    If you ignore the rapidly amassing liabilities destined to crippling our economy in the next 20 years, yeah, it's working great.

  • BYODB||

    But Republicans are just as bad because...hmm...well I got nothing here. Even spend-crazy Republicans can't hold a candle to this yahoo.

  • Loup-Bouc||

    The studies are biased against single payer systems. The article states "issues" according to libertarian or neoconservative Republican bias.

    Example: The article asserts that "[s]upporters of single-payer...[must] convince Americans that it is worth paying twice (or more)...taxes...to get 'free' health care (and abolish premiums, co-pays, and deductibles)."

    But Medicare involves premiums, co-pays, and deductibles. If premiums, co-pays, and deductibles are accounted, tax-cost drops, markedly.

    A vital question is whether Sanders's proposal includes premiums, co-pays, and deductibles of amounts that will cut tax-cost & make net cost adequately bearable — compared with Obamacare or no government program. I do not know the answer, because I have not read Sanders's proposal — for lack of enough time & because I doubt corrupt Congress & Trump would pass it even if its virtue were beyond stellar.

    The political question is whether enough Americans will demand an efficient single payer system. But that question begs the question whether enough Americans obtain brain-transplants that will enable them to THINK — so they can research & analyze intelligently the economics of a proposed single payer system — compared with Obamacare or no government program.

    Since I expect the 2nd question's answer must be negative & since my time is very much devoted to designing & prosecuting habeas corpus petitions to free people unjustly convicted & incarcerated, I bid the matter adieu.

  • TxJack 112||

    We have an excellent example of a single payer system in this country, the VA. Do you think anything developed by the Feds will be better. We already know thousands of vets have died waiting for care or been denied the type of care they need. Bottom line is this country is too large for a single payer system to ever be feasible. When a country the size of the UK finds it impossible, how does a country 10 times bigger make it suddenly work.

  • Happy Chandler||

    Propaganda

    The VA provides quality of care equal or better than private insurance. Wait times are not significantly different.

  • Sevo||

    "The VA provides quality of care equal or better than private insurance. Wait times are not significantly different."

    You bet! That's the reason the vet flock there instead of elsewhere:
    "Billions spent to fix VA didn't solve problems, made some issues worse"
    [...]
    "A commission tasked by Congress with trying to fix the troubled Veterans Health Administration has just concluded a damning report, finding that "many profound deficiencies" at the troubled agency "require urgent reform."
    The commissioners conclude, "America's veterans deserve a better organized, high-performing health care system."
    The report indicates the billions pumped into the VA since the wait-list scandal erupted two years ago have failed to relieve many of the problems in delivering health care to veterans. In some cases, the report points out where so-called improvements to the VA system may have actually made things worse."
    https://www.cnn.com/2016/07/05/politics/
    veterans-administration-va/index.html

  • Happy Chandler||

    Learn how to post a link.

    The commission was stacked with privatization advocates. That's why I prefer RAND and other independent studies.

  • Red Rocks White Privilege||

    Lol:

    The variation between individual VA facilities was large on some of the quality measures. For example, there was a 50 percentage point difference in performance between the lowest and highest performing VA facilities during 2014 on the rate of beta blocker treatment for at least six months after discharge for an acute heart attack.
    The study did not examine issues related to accessing care in the VA health system, such as whether enrollees gain access to care in a timely manner.

    When you're being graded on a curve, it's easy to claim you perform better.

  • MarkLastname||

    IOW, you ignore anyone with an opinion contrary to your preconception. A great way to train yourself to reason circularly.

  • ||

    The VA provides quality of care equal or better than private insurance.

    You've clearly:

    1) Never dealt with the VA.
    2) Never known anyone who has.

  • Happy Chandler||

    You've clearly never dealt with someone who has private insurance.

    The VA fell behind in Arizona largely because they did not account for both the high number of covered veterans from Afghanistan and Iraq coming home and the older veterans retiring to Arizona. But, most other places had much less problems.

    The plural of anecdote is not data.

  • ||

    You've clearly never dealt with someone who has private insurance.

    I have private insurance. So do most people I know. Except the vets, who have VA.

    The plural of anecdote is not data.

    And a bunch of eggheads gaming metrics to say something contrary to the experience of literally everyone is irrelevant.

  • NashTiger||

    You think the problems were limited to Arizona?

    In Murfreesboro TN, and 3 other locations, they gave patiens Hepatitis and HIV, because the staff couldn't be bothered to properly clean colonoscopes

  • Fuck you, Shikha (Nunya)||

    Tell my aunt's family how much they miss it over their private insurance they have now. I'm shocked, shocked I tell you, they won't go back!

  • NashTiger||

    The improper use and buzzwording of the term "neoconservative" is a bright flashing neon sign that says "I think I know more than I do, and don't realize what I don't know is like an ocean to my droplets of wisdom"

  • Loup-Bouc||

    "Neoconservative" bears two meanings: (1) Hegemony & foreign-intervention, etc., & (2) "new"-form conservatism, an ingredient of which is "modified" free-market economy
    that involves, among else, these: the favoring of supply-side economics (despite contraindications), relaxed limits of budget deficits, governmental "moral" guidance (economic & other), virtual rejection of Hayekian condemnation of big government & welfare (neoconservatives adore "corporate welfare" (subsidizing corporations sundry ways). See, E.G.,
    www.britannica.com/topic/neoconservatism
    AND the "Views on Economics" section of
    https://en.wikipedia.org/wiki/Neoconservatism

    The matter is complex & muddied by philosphical, sociopolitical, and economic disagreement among neoconservatives. See the comment I shall put as "replying" to THIS comment.

    In the context of my main comment, the appropriate "neoconservative" meaning is the one I adumbrate above, NOT the one that involves, E.G., pursuit of hegemony & military or regime-change foreign intervention.

    So, "NashTiger, try learning before you blather

  • Loup-Bouc||

    In my 30 July 2018, 6:46 PM comment replying to NashTiger (30 July 2018, 5:18 PM), the 2nd paragraph is:

    "The matter is complex & muddied by philosphical, sociopolitical, and economic disagreement among neoconservatives. See the comment I shall put as "replying" to THIS comment."

    Respecting that paragraph's point, see, E.G., this:
    www.jacobinmag.com/2015/04/neo.....ulture-war

  • NashTiger||

    Your unconvincing wall of text aside, the fact that you think opposition to single-payer is "neoconservative" by either of your (incorrect) definitions is embarrassing and disqualifying in and of itself.

    A Neoconservative is an erstwhile Liberal (most of whom were Jewish) who broke with the Democrat party in the 70s over the dramatic shift Leftward in foreign policy.

    Opposition to socialized medicine is more Paleo, and any and all other italicized or non-italicized versions of Conservative

  • Loup-Bouc||

    NashTiger

    Your comment's final ¶ is not a sentence. Also, it is word-salad.

    *

    Your 1st ¶:

    Its language "by either of your (incorrect) definitions" is a dangling prepositional phrase (so, nonsense).

    The term "is embarrassing" permits that YOU are the embarrassed party, as you ought be.

    Neither "neoconservative" nor any other proper term — rather than comment-system-rule-violating word(s) — can be "disqualifying" of anyone or anything in a context of commenting on Reason articles.

    The language "wall of text" is bad pseudo-poetry & incoherent.

    The language "in and of itself" is doubly redundant:
    (a) in itself = of itself
    (b) Your sentence did not modify "is disqualifying." Hence, "in and of itself" is superfluous.

    *

    Your 2nd ¶ suffers sundry troubles — including partly (& significantly) false history. But, because of space-limit, I shall treat only one flaw: What is the relevance of whether any early neoconservative was "Jewish" (relevance outside minds of neo-Nazis, anti-Semites, White supremacists)?

    *

    I grant you this: In my main comment (30 July18, 4:22PM), the 2nd sentence ought to have included "neoliberal" bias with "libertarian or neoconservative Republican bias."

    *

    I might pray you be spared your delusions — were I not an apolitical, anti-religion atheist, law professor, statistician, physician, linguist, logician, Magyar, Lithuanian, Ukranian, part-Jew. [All true, but partly sarcasm & humor of the absurd.]

    Cheers.

  • Red Rocks White Privilege||

    Fuckin' LOL at anyone citing Jacobin unironically.

    Begone, commie scuzzbag.

  • Loup-Bouc||

    To increase the chance that you will see my 30 July 2018, 6:50 PM comment, which I put as if a comment replying to my 30 July 2018, 6:46 PM comment replying to NashTiger (30 July 2018, 5:18 PM), I shall re-post my 30 July 2018, 6:50 PM comment here-below:

    In my 30 July 2018, 6:46 PM comment replying to NashTiger (30 July 2018, 5:18 PM), the 2nd paragraph is:

    "The matter is complex & muddied by philosphical, sociopolitical, and economic disagreement among neoconservatives. See the comment I shall put as "replying" to THIS comment."

    Respecting that paragraph's point, see, E.G., this:
    www.jacobinmag.com/2015/04/neo.....ulture-war

  • Loup-Bouc||

    Another consideration is Medicare's bargaining power — immense (which explains why some medical-service providers refuse to accept Medicare-covered patients). Often, Medicare will bargain-down & otherwise cut by 90% or more the patient's charge of a several-thousand-dollars or greater medical-service-provider's invoice.

    So, when one considers whether to support "Medicare-for-all," one must consider the likely ratio of Medicare tax plus premiums & deductibles less bottom-line medical-bill savings. And the net saving is money one can spend or invest, and the spending or investment increases market profits and employment, hence tax-revenues, the tax-revenue-increase offsetting potential federal debt.

  • Sebastian Cremmington||

    The only people dumber than the people defending the status quo are people promoting Medicare for all!! How will Medicare determine prices and allocate resources without the private market?? The people in the group market are satisfied with paying for something everyone else gets for free and you want to change that?? So stupid!

  • TrickyVic (old school)||

    Federally Qualified Healthcare Centers are often heavy on patients with Medicare, and Medicaid. They also get a chunk of their money from HRSA grants. Medicare and Medicaid doesn't cover their operating costs.

  • Loup-Bouc||

    For a different perception of the cost of Sanders's proposal, see
    www.truthdig.com/articles/medi.....ten-years/

    That source argues that the $32.6 trillion cost-allegation is a false assertion of a very biased source.

    But view the above-referenced article critically; for, it is an argument of a left-perceiving mind. One may expect that the true cost is other than ANY argued ANYWHERE (at least at any source I have encountered).

  • Migrant Log Chipper||

    FOAD, troll, into the woodchipper you go.

  • shamrock||

    I'll just spitball here. There are roughly 100M employees in the US. If the average corporation is paying $5k/year for health insurance benefits for each employee that's an expense of $500B/year, or $5T over 10 years which they would no longer have to pay. Oh shit, that doesn't even come close to covering it.

  • Happy Chandler||

    1) The average group plan costs much more than that.
    2) The average worker also has dependents, so double your already lowballed number.
    3) Include out of pocket expenses for employees, deductibles and copays.
    4) Also, include the costs of Medicare, Medicaid, charity care, VA care, and the other myriad ways health care is funded.

  • JFree||

    That's not close to the correct size spitball.

    Avg corporate healthcare costs/employee (combining singles and families) is $12,200/year. There are roughly 130 million full-time employees. So that's $1.7 trillion/year - or $17 trillion over 10 years (w no inflation).

    Further, they keep those costs down in no small part by discriminating against older employees - and the whole part/full time thing. Which is not a cost for them - but is a distorted behavior that has a significant economic impact.

  • NashTiger||

    Who discriminates against older employees?

    I'm interested in learning, since I merely deal with HR, CEO, and CFO decision makers, and explain benefit packages and enroll employees all day long (when not commenting to dummies on the internet)

  • Fuck you, Shikha (Nunya)||

    Uh, age discrimination is already illegal.

  • JFree||

    Whew! Guess that means it can't possibly exist.

  • Loup-Bouc||

    Good point.

    But a question is whether a single-payer program would payroll-tax employers, and, if so, whether the tax would be greater than current health-insurance benefits-payments employers make now.

  • Tony||

    So even Mercatus says overall health spending goes down. Big picture: Do you value universal healthcare or not? If not, just say so, and stop bitching about rationing (not having the money to afford to get treated is the most brutal form of rationing). If yes, then nobody really accepts the status quo as the best possible world. And libertarians don't really offer an alternative. Might as well go for single-payer in some form, because at least it's simple and doesn't throw a giant ballistic buzzsaw into the market like the current mishmash does.

  • TxJack 112||

    All you have to do is look at the cancer rates between the US and the countries of western Europe to see how "effective" a single payer system truly is and why it does not work. For example, the death rate for women from breast cancer in the UK is 56% higher than the US. The reason is simple. There are four drugs used by doctors in the US to treat breast cancer. In the UK there is only one. The drug women receive in the UK is the oldest one and the least effective. Why are they limited to this one drug? Cost. The newer more effective drugs cost more and the system cannot afford to provide them. If the woman being treated was your wife, sister or mother, would you be willing to look at her and say, "Sorry this is all you get. Good luck" knowing her chances of dying would be 50% higher than they are right now? I doubt it.

  • Tony||

    No dispute that you can pay for the best treatment in the world in America compared to treatment you don't have to pay for in Britain. My significant other just lost most of his inheritance because his dad got cancer. Now I have to come up with a new retirement plan.

  • BowserB1946||

    So rather than save for retirement, you were counting on your boyfriend's inheritance? Wow. You've got to be a Democrat!

  • Tony||

    I have saved plenty, I was just counting on retiring really early.

  • Don't look at me.||

    You are a ghoul.

  • Fuck you, Shikha (Nunya)||

    That says a lot.

  • Nardz||

    "My significant other just lost most of his inheritance because his dad got cancer. Now I have to come up with a new retirement plan."

    This is honestly the funniest thing you've ever said, Tony.
    Bravo!
    Morbid, but true

  • Tony||

    And let's be thorough while we're at statistics. Overall cancer rates are actually better in Britain (396 per 100,000 people in the UK vs. 451 per 100,000 in the US).

  • JunkScienceIsJunk||

    Western Europe and the UK are not the same thing. Netherlands, for example, has far more sophisticated breast cancer treatment and diagnostics than most of the United States (due in part to their softer regulations in many ways...). But they also spend more than the UK as a function of GDP. There's obviously a lot more that goes into it than just are you socialized or not. It ain't binary.

    The other issue with the US is that we overtreat like a motherfucker. Especially in cancer. I know it's heresy to say this, but patients make too many decisions (spoken only from an economic standpoint, not an ethical one).

  • JFree||

    I know it's heresy to say this, but patients make too many decisions (spoken only from an economic standpoint, not an ethical one).

    This 100%. I'm convinced that the reason other countries save money with better outcomes is because they have a much much bigger role for PCP's as gatekeepers.

    Those doctors have the medical knowledge to know how to control specialist utilization.

    And those other systems - for the patient-PCP relationship - get preventive/minor care often. Don't limit access at all. It's very cheap so the main point of all that for the patient is - find a PCP you can trust and then let them be your agent for that time in the future when you will need that. Ours is - for PCP/patients - get on the PCP treadmill hamster - and during annual enrollment next year we've got an entirely different treadmill for you.

  • JunkScienceIsJunk||

    I don't mean just that, although you're probably right. I mean we overtreat for cancer generally. It's a proven fact that more people receive surgery than they should. It's a proven fact that more people receive chemotherapy than they should. And for breast cancer (my specialization), there are expensive drugs that have hit the market the last few years that are being prescribed to patients who will NOT benefit from them because the treatment guidelines (NCCN, ASCO) are too simplified to parse these groups appropriately. The advent of "personlized medicine" should serve to better refine patient selection, but we're definitely not there yet.

  • JFree||

    I agree. My dad had all that happen in his 80's re prostate screening/cancer.

    The specialists were selling their book. What he needed was a geriatrician to ask the right questions and help him work thru the bigger picture. What he got was some semi-ignorant guy like me asking the right questions (and Google search placements re proton beams that are simply deceitful). Ultimately he got lucky and found a geriatrician. Something is really wrong in our system when that is the decision-making process.

    It's stunning that prob $500+ billion or so of annual healthcare spending is simply unmanaged and overspent - because we think 3000 practicing geriatricians and dropping (roughly the same number as Denmark) is enough to help 55 million Medicare beneficiaries (and rising) when the decisions start getting complicated.

  • Happy Chandler||

    The difference is detection rates. Many Americans are treated for small, slow growing cancers that would not pose a threat during the patient's lifetime. The treatment does not improve, and can even reduce, the expected life. It certainly produces negative effects, at great cost.

    America overtreats many people, undertreats the rest, and does it at great cost and kills more people doing it.

    Maternal deaths during and after childbirth is a good example. America is behind the rest of the world, and more women are dying than a decade ago. Many of these deaths are preventable.

    Commie California has a concerted effort to get best practices in maternity suites, and has the lowest death rate in the country, going down while the average goes up.

  • NotAnotherSkippy||

    That garbage again. Not controlling for population and measurement differences, of course.

  • JunkScienceIsJunk||

    He's right about most of that though. Prostate cancer for sure. Breast cancer definitely. Thyroid and many other "incidentalomas" are overtreated because 1) we don't have the right diagnostic tools to adequately rule-out; 2) we over-rely on molecular tests and blood tests; 3) people are afraid of the C word and make irrational decisions as a result.

  • Happy Chandler||

    The difference is detection rates. Many Americans are treated for small, slow growing cancers that would not pose a threat during the patient's lifetime. The treatment does not improve, and can even reduce, the expected life. It certainly produces negative effects, at great cost.

    America overtreats many people, undertreats the rest, and does it at great cost and kills more people doing it.

    Maternal deaths during and after childbirth is a good example. America is behind the rest of the world, and more women are dying than a decade ago. Many of these deaths are preventable.

    Commie California has a concerted effort to get best practices in maternity suites, and has the lowest death rate in the country, going down while the average goes up.

  • LynchPin1477||

    So even Mercatus says overall health spending goes down

    Under the optimistic assumptions that Sanders is making.

    And libertarians don't really offer an alternative

    https://www.cato.org/research/health-care

    I suspect you mean that libertarians don't really offer alternatives that check the boxes you want checked, which is fine. But there are numerous market-oriented alternatives to single-payer that libertarians have championed for years.

  • BowserB1946||

    I disagree with pretty much everything the Democrats say. However, it does seem like we're not really getting value for our health care expenditures. The U.S. spends more per capita than any other nation on healthcare. At the same time, we rank 31st in life expectancy. I've been looking at this off and on for a number of years. The first time I looked, we were number one in per capita cost and tied for 16th in life expectancy. We're still number one in spending, but down to 31 in life expectancy.

    I don't really have answers, and I know any change will require an expensive and painful transition where people who have paid all their lives will pay more to cover those who have never paid. In the end, we might be better off, but it's a scary bet.

    The one thing I do know about costs and life expectancy is that the countries with low cost and long lives have largely homogeneous populations and do not allow unrestricted immigration or have large populations of illegal immigrants. We here in the U.S. truly have the worst of all worlds, so we're likely to continue on top of expenditures and far down the list in life expectancy.

  • Happy Chandler||

    Canada is an example. They have lots of immigration and a population that is similar enough to here to compare.
    They spend less and live longer. Also, they shoot each other far less. There is basically zero push for a US style policy up there.

  • swampwiz||

    So why don't we tax guns & bullets to pay for the increased health care costs due to the mayhem?

  • ||

    They have lots of immigration and a population that is similar enough to here to compare.

    Um . . . no, they don't. They have 1/10 the population and are 75% white.

  • Hidebehindyourcause||

    HC posts statements based upon feelz, not anything like facts

  • Fuck you, Shikha (Nunya)||

    HC version of similar. They have immigration. They have white people. They're almost identical!

  • NashTiger||

    There are also more MRIs in metro Detroit than in Canada. And there is no wait for a veterinary MRI, up to 18 months if you are bipedal. So enjoy that hip and back pain

    Of course, they live longer in canada,, because they come here for the most challenging cases and treatment. But, say, if you hit your head while skiing in Canada, you live a lot less long, i. e. like Natasha Richardson

  • Sebastian Cremmington||

    Wrong, Canadians live longer because of their lifestyle. So we actually have a group of people with 100% insurance—American children! European children are healthier than American children because of lifestyle. We clearly have the best health care system in the world but we are also clearly not getting value for our spending. That said the people actually paying for health care, the people in the group market, are satisfied overpaying for health care...so why change it??

    Reforming Obamacare is the way to go which is "Medicaid for all" unless you have a good job or are over 65. And the reality is Obamacare is a program for doctors and hospitals and not for the people on Obamacare who should be trying to get a good job or biding their time until Medicare. Just expand Medicaid to 350% FPL and move on but unfortunately that will never happen because Kushner's brother is involved in the Obamacare Exchanges so we are stuck with them!

  • LynchPin1477||

    Be careful about correlations between spending and life expectancy. So many things go into the second that are unrelated to the first. If you have a population that is overall less healthy you might actually expect both higher costs and worse outcomes.

    It's also not really clear how a large immigrant population, legal or otherwise, impacts all of this.

  • MarkLastname||

    Try reading the article again, and pay attention this time. Mercatus reaches that conclusion only by not challenging the spurious assumptions of Bernie's plan, such as Medicare's administ cost rare extending to the rest of the population.

  • TrickyVic (old school)||

    ""So even Mercatus says overall health spending goes down.""

    And that makes it so?

    There is no health spending goes down. The Affordable Healthcare Act, didn't bring prices down like they said it would. The term "Affordable" is a joke.

  • Empress Trudy||

    And just think, with the bazillion illegals Reason can't wait to welcome here that number can only go up and up. Talk about 'reasonable' expectations of entirely foreseeable consequences.

  • JunkScienceIsJunk||

    Or it could go down. Especially if immigrants contribute more economically than they take. Which Reason ALSO wrote about not too long ago...

  • Don't look at me.||

    IF. We don't know for sure.

  • JunkScienceIsJunk||

    Well, sure. We know RIGHT NOW that they contribute more than they take. Would that continue with open borders? My guess is that it would. The types of people who won't cross the border now because they're afraid of breaking the law are probably more likely to contribute than the types of people who are crossing the border now, IMO.

  • Micu5||

    Fortunately under true socialism there are no prices. Problem solved! Now, where did I park my unicorn...?

  • Curly4||

    Medicare for all may cost only $32 trillion in 10 years (I think that number is far below its real cost) which would add $3.2 trillion per year to the national budget. A budget that we now have to borrow near a trillion a year just to cover. When 3.2 trillion more per year that would be 4+ trillion that has to be borrowed which would double the national debt that we now have in just FOUR (4) years. Or there would have to be an increase in national taxes of about $4 trillion a year. That would cause many to look for another nation to reduce their taxes. Taking that much taxes from the economy would cause a contraction of employment and inflation at the same time. With more unemployment more would be turning to the government for entitlements (what has in the past welfare) just to survive. This in itself would reduce the amount of money that could be taxes thus increasing the national deficit which would have to be covered by more borrowing or higher taxes.
    What would be a much better solution would be for the government to have a tax and regulation policy that would increase business and employment and a change of health insurance policy that would encourage people that is not covered by company provided health insurance to form coops to get group rates. This cheaper rates for health insurance would allow more people to be able to get insurance and be proud of the fact that they are not dependent on the government.

  • JunkScienceIsJunk||

    Medicare for all may cost only $32 trillion in 10 years (I think that number is far below its real cost) which would add $3.2 trillion per year to the national budget.

    This operates under the assumption that revenue would stay the same. And that Americans (and their employers) would use the money they currently spend on health care instead on weed and hookers.

    I think the better assumption is that Bernie would offset this increase in spending with an increase in taxation. Maybe not all of it, but some of it. All this plan does is take it out of the purview of private companies and put it into the hands of the government. It doesn't add net burden unless it operates in an inherently more inefficient manner. Progressives argue that the government is more efficient because it's not for-profit. Conservatives argue that the private industry is more efficient because competition.

  • TxJack 112||

    Let's look at one undeniable truth, the Federal Government is unable to provide quality healthcare in a timely manner to Veterans, so exactly how will they do it for everyone? Doubling the tax revenues would destroy the economy and halt growth. The debt the country would incur would drop us to the status of a 3rd world country. &0 Democrats in the House have already proposed a bill for a single payer system. A key component of this bill is the outlawing of all private health insurance. So to get people to accept this form of healthcare, the only option to make any other type of healthcare illegal. Why do you think Democrats really want a single payer system? Simple, control a person's healthcare, you control the people. Remember, Obamacare required doctors ask patients if they owned guns. Even though you have the right to refuse to answer, the fact the requirement is part of the law demonstrates the danger of a government run system. What will be do when a government run system requires us to surrender our guns or be denied care? I doubt this proposal will ever see the light of day because it is simply not fiscally feasible but you can never say never.

  • Tony||

    The beauty of a mixed system is that all those veterans who hate their healthcare are perfectly free to get it on the open market.

  • Get To Da Chippah||

    The beauty of dodging painful truths is that you don't have to address them.

  • BYODB||

    Someone has no experience with Tricare, I see.

  • Tony||

    Correct me if I'm wrong, but there is no law that says you are forbidden from taking your money and buying healthcare in the market if that's what you want to do, right? And it's a benefit paid for by taxpayers, so it's not like they're out any money by refusing VA care. So if it's so bad compared to the market, seems like the problem would take care of itself naturally.

  • Sevo||

    Tony|7.30.18 @ 5:27PM|#
    "Correct me if I'm wrong, but there is no law that says you are forbidden from taking your money and buying healthcare in the market if that's what you want to do, right? And it's a benefit paid for by taxpayers, so it's not like they're out any money by refusing VA care. So if it's so bad compared to the market, seems like the problem would take care of itself naturally."

    Yes, you can pay for medicare in your taxes (at the point of a gun) and then pay for real medical care out of your pocket, and that will cause the taxes taken at the point of a gun to go away.
    Do you post here to prove how imbecilic a human can be, or is that a side benefit?

  • Tony||

    It's (too) complicated, but generally you're not really paying for your own Medicare. You will have paid in during your working life, but you could also croak at 64 and not see the payoff, as is the nature of the insurance concept. Although you would be free of the premiums, a not insignificant source of funding for Medicare.

    I agree that most rational people would take the cheaper option, but why doesn't the free market offer one?

  • MarkLastname||

    Imagine the government started its own fast food chain, put one in every corner, charged below cost or free while making up the difference with tax money, and forced the other restaurants to price goods similarly to them while providing a very similar menu; they start to go out of business until the government bails them out to kerp the decrepit market from collapsing.

    Tony wanders in to wonder why the private restaurants don't offer a diverse array of meals suited to individual customers' needs at reasonable prices...

  • NashTiger||

    She Guevara already outlined how we pay for this on The Daily Show without John Stewart.

    You see, we reverse the Trump Tax cuts, Fair Share, and Private Equity something

  • mpercy||

    Don't forget the carbon tax!

  • NashTiger||

    Yes, that gets us to 100% renewables, but I'm not sure how exactly that pays for Healthcare. I'll have to ask her Nobel braintrust to explain that to me, because I am not credentialed and don't even use the Gini Coefficient in daily conversation.

  • Sevo||

    "A plan to bring single-payer health care to the United States by expanding Medicare to cover nearly all Americans would cost more than $32 trillion over the first 10 years."

    Keep in mind this is the "estimate". Double it, at least.

  • Cory Crockett||

    This precisely why taxation should be abolished: "When Congressional-Spendthrifts (like Senator Sanders) are bereft of Their fiscal feeding-tube reality will be permitted to reside in its place."

  • BowserB1946||

    How can he call it "Medicare for all?" Medicare is a plan that you pay for over 45 or 50 years, along with a matching payment from your employers. Then you get the Medicare coverage--only part prepaid, and part you continue paying for, plus for decent coverage, you buy a supplement.

    Bernie's proposal is just free medical coverage paid for by … who knows? Probably partly covered by Bernie's recommended surtax on IRA and 401(k) withdrawals. In other words, he wants the people who have paid for Medicare all their lives, to also pay for free medical care for everyone else. Now this is the mark of a true Communist.

  • Happy Chandler||

    Paid for by the same money currently going to health insurance premiums and copays, with money left over. How exactly to get there is a negotiation process.

    But, at this point, the answer to how will we pay for it is exactly the same as how will we pay for the Republican $1.3 trillion spending bill they passed earlier this year, right after the tax bill.

  • Don't look at me.||

    Said the guy who never made any money.

  • mpercy||

    Simple...just make illegal for doctors, nurses, PAs, etc. to work for anyone except the federal government. Cap their pay at $50K per year (we may have to incarcerate a few, or a few hundred, before they figure out we're serious about not working outside the system). Nationalize the hospitals, dr's offices, clinic, medical testing labs, etc. and run them at cost too. Nationalize all the Big Pharma and device makers, to force them to run at cost. Cap all their salaries, too. Since all the healthcare is now "free" there's going to be no insurance company greed in the system. Since everyone's pay is capped, there's no profit motive or excess greed involved. So it all has to be cheaper than what we're spending now, right? And it will of course be better since the government is running things across the board, top to bottom.

  • MasterThief||

    It's interesting that proponents of single payer don't see the inherent necessity of doing all these things. It is actual socialism and fascism. Freedom and guaranteed outcomes do not go together.

  • swampwiz||

    Let's see ... Presumably the only folks not covered by this would be seniors, who are already on Medicare. with a senior population of 13.4% and a population of 328M, that means a covered population (now) of 284M, and with a growth rate 0.7% per annum, the average number of covered will be 294M, and so $3.2T per year means $10.9K per year. As an "able-bodied", "early retired" Medicaid-expansion beneficiary, I don't buy a policy from the ObamaRomneyHeritageCare Exchange, but the policy alone would cost me about $12K per year as an early 50s man, so it sounds like Medicare-For-All is already ahead of the game just in premium alone, and I get free dental care to boot.

    Oh, and just because the enemies of health care have tried to "drown the government" by irresponsible tax cuts doesn't mean that we have to be suddenly be cheap. And a larger national debt might give Trump what he really wants: a devaluation of the USD!

  • Don't look at me.||

    Think of anything that the government runs for your direct consumption, street plowing, garbage pickup, drivers licenses, the IRS, etc. Are you pleased with the level of service you get and would you recommend them to your friends? Do you want the same folks deciding the fate of your health?

  • Spookk||

    So what? Just reduce our stupidly overloaded defense budget by whatever it costs.

  • perlchpr||

    My god, this is brilliant!

    I'm going to pay for my new Ferrari by cutting out McDonald's!

  • Bill||

    The entire defense budget for 2018 is 700 billion. If you cut it in half,
    that 350 billion is only about 10% of the 3.2 trillion cost per year of
    Bernie's plan.

  • Deconstructed Potato||

    And yet, despite that effort to usurp a fundamental constant of all quantifiable resources, every is still relative.

  • Deconstructed Potato||

    Oh boy sorry I think I dun read that wrong.

  • Deconstructed Potato||

    Put this comment in response to spookk

  • DrZ||

    "A plan to bring single-payer health care to the United States by expanding Medicare to cover nearly all Americans would cost more than $32 trillion over the first 10 years"

    Well it's free in that we aren't paying for it, our descents will be covering the bill. Let's go for it!

  • RenaD||

    We can talk costs and processes and delivery systems and whatever until we are blue in the face but none of it matters. As Sarcasmic points out above, this is a moral issue for most people, who consider healthcare a right. Never mind that most are easily capable of paying anywhere from $500 to $1000 a month for groceries, without which they would die faster than if they had no health insurance. But tell them they should budget in a similar manner to take care of their bodies and minds? And suddenly you are a monster.

    Until the Republicans in Congress get enough balls to come out and say that health care is not, in fact, a right, that government needs to stay out of it so prices adjust and we all start budgeting for it just like we do our groceries, rent/mortgage, and utilities, well, be prepared to bend over. As far as I can see there is nothing that can stop the single payer train.

  • Robert||

    Why didn't they think that 100, 200, 300 yrs. ago?

  • RenaD||

    Huh?

  • Flight-ER-Doc||

    $32Trillion.....

    And could someone tell me when the last time a government (at pretty much any level) project ONLY cost the initial estimates?

    We have moved into the end times of Heinlein's crazy years, that this is actually being discussed.

  • Barry Gold||

    How does the study explain comparisons to Japan and most of Western Europe? Almost all of these have some form of "single payer", and they spend roughly 8% of their GDP on healthcare. The US, with private healthcare, spends about 16% -- twice as much in comparison -- and our outcomes are no better.

    As a libertarian, I've found this troubling, and haven't seen any explanation that accounts for this fact -- if it *is* a fact. My basic principles say that a free market in medical care should deliver the best results, but the comparison with Europe does not support this.

  • Don't look at me.||

    We do most of the research and make most of the new drugs and medical tech.

  • ||

    My basic principles say that a free market in medical care should deliver the best results, but the comparison with Europe does not support this.

    You seem to assuming that we have a free market in medical care.

    What we have is the good-old American System - capitalistic socialism that's twice as expensive as both and less effective than either.

  • NotAnotherSkippy||

    For actual medical treatment, our system is better than almost anywhere except Switzerland or Singapore. The fact that these studies typically don't control for populations and measurements and include things like "equality" in their definitions tells you how honest they are. And as noted above, the US subsidizes the rest of the world with drug and device research. They pay the marginal cost of production while the R&D costs are borne back here.

    Cue the JunkScience 'tard about how all drugs are NIH funded and phase 1-3 trials are just development and not *real* research.

  • JunkScienceIsJunk||

    Thanks, you beat me to it. All drugs *are* NIH funded (I provided a citation last time I showed you this). And yes, developing a drug is development.

  • JFree||

    A better way of looking at it honestly is:

    We spend a higher % of GDP - via our govt - than any country except Norway. The difference is - every other country can pretty much cover all the basics and normal stuff for everyone with that. We can cover only the elderly, permanently disabled, and poor.

    The problem is our public system is almost deliberately designed as an inefficient rent-seeking scam. And rather than fix anything, our political parties seem wedded to their basic political philosophies - roughly let's make the scam bigger or let's kick granny and the poor in the teeth

  • Qsl||

    Typically as prices rise, that is an indication for more players to become involved and innovate to get their piece of the pie, but for numerous reason from restricting the number of providers, restricting what those providers can legally do, and involving a third party (insurance) to oversee the entire market, etc. you have a closed system. In many respects the US health market is a victim of a type of regulatory capture.

    On the other hand, you have the government which can often bypass those inefficiencies, but often introduce problems of their own (I've witnessed both first hand and there are aspects where the government excels, and others where the private market excels).

    The libertarian fallacy is in viewing markets as a hammer and everything else as a nail. Markets left unfettered will innovate towards extended life expectancy at any cost while government systems tend towards improving efficiency (re: rationing) and driving costs downward.

  • Bill||

    We don't have anywhere near a free market in medical care.

    The AMA licenses the medical schools and only they can
    do it by law. Medicare and Medicaid have been in place
    for a long time and have a big impact on the pricing system.

    And the main reason we have employer paid health care is
    due to FDR's forbidding companies to give pay raises during
    the depression so companies came up with health care since
    they could not give raises. That has now been enshrined into law
    through all the tax incentives if companies do provide health insurance.

  • josh||

    The take away from some on the left is quite different. I can't get the link to work, but the sit is www.jacobinmag.com and the headline is "Even Libertarians Admit Medicare for All Would Save Trillions".

  • josh||

    *site

  • Migrant Log Chipper||

    Fuck off, you Marxist scum bag or you'll be first in line for the chipper.

  • Deconstructed Potato||

    The People's Commisariat for the Processing of Wood has been informed of your intention to operate wood chipping equipment without the necessary licensing and oversight. You will be brought in for questioning and your family will be relocated.

  • MarkLastname||

    Communists seem to have difficulty reading.

  • MasterThief||

    One of the problems is that this study used all the presuppositions of the bill's proponents. Put in some sparkly bullshit and it's hard to not have a glittery output.

  • jerbigge||

    How much is our total cost right now? Spread over the next decade it is likely to be more than the $33 trillion mentioned. So from the standpoint of economic efficiency a "single payer system" is likely cheaper than what we now have. Basic grade school math.

    However there are other ways to reduce the cost of health care. One is to repeal FDR's 1938 prescription laws which were passed to give MD's a legal monopoly over access to medical drugs. Repeal this and suddenly health care, at least the maintenance of it, will fall by an surprisingly large amount. For example, the cost of controlling your blood pressure and cholesterol (using Walmart pharmacy prices) works out to about $80 a year. Since these are chronic conditions that can be medicated, but not cured, eliminating the unnecessary office visits and lab tests more frequently than semi-yearly will save a considerable sum of money.

    Consider too how the "free market" in the form of Walmart's Relion Novolin insulin reduces the cost of insulin by a factor of almost 10. Going by experience, eliminating the economic transfers of insurance, the cost of the modern brand name insulins is about $8,000 a year. However using Walmart's insulin, the cost is only about a tenth of the above figure.

    No doubt there are similar possible savings if the power of the AMA is brought under control.

  • Sevo||

    jerbigge|7.30.18 @ 7:31PM|#
    "How much is our total cost right now?"

    What ever it is, it is already screwed by government distortion of the market and it would only get worse if that idiot Sanders had his way.
    Oh, and fuck off, slaver.

  • Nardz||

    Um, pretty sure he's arguing for less regulation which would lead to more competi9and lower prices

  • maddarter||

    More people covered for more things at less cost. Whether you call it taxes, prices, premiums, copays, coinsurance, etc -- you are still paying.

    http://www.vox.com/policy-and-.....st-voxcare

  • John B. Egan||

    OMG! $32 TRILLION in TEN YEARS? What will we do? What WILL we do? .... We already spend $3.2 Trillion each year and it's climbing!

    $3.2 Trillion X Ten = $32 Trillion

    In other words, we already spend that much. Even if the price tag was the same, we could cover everybody.

    And this cost estimate was produced by a Koch Brothers lackey. The Kochs have been fighting Single Payer for a decade. They fund lying reports like this. In fact, every other developed nation with Single Payer pays 1/2 per capita that which we do for better health care, covering everybody. Is there some reason why Americans are incapable of emulating other nations? Are we that stupid?

    Why would we not aim towards $1.6 Trillion per year and covering everyone with a better and simpler system? Duh!

  • NashTiger||

    OH NOES!

    KOCH BROTHERS?!?

    Well, now you've sold me

  • Deconstructed Potato||

    God bless Kochistan!

  • NotAnotherSkippy||

    Apparently they even fund the far-right Urban Institute who fund basically the same thing.

  • Deconstructed Potato||

    My sarcasm detector is malfunctioning. As such I do not know how to respond to this, if at all.

  • Sevo||

    John B. Egan|7.30.18 @ 7:42PM|#
    "OMG! $32 TRILLION in TEN YEARS? What will we do? What WILL we do? .... We already spend $3.2 Trillion each year and it's climbing!"

    YOU pay for it slaver. And fuck off.

  • vek||

    Actually they pay less money for WORSE health care, but everybody does get it.

    Our spending in the USA on new devices and medicine is the only reason they can spend so little too. We pay to develop everything new, and they just get to free ride off our spending.

    There is no free lunch. We can either have better care for more money, or lesser care for less money. There's a reason rich people from around the entire world come to the USA for treatment my friend!

  • Cyronic||

    Right, because opening guaranteed healthcare to everyone while simultaneously forcing doctors to accept price-fixed Medicare nonsense isn't going to affect the prices government pays at all.

    Sounds more like this is going to create a double-whammy effect of greatly increasing demand while reducing incentive to increase supply. If you know anything at all about economics, you should know that this 32T number is making a lot of optimistic assumptions. Most likely, the number will be many trillions higher.

  • wearingit||

    Fair to look at the 32 trillion dollar cost. What is not fair is leaving out that it saves about 300 billion over the current system.

    You can argue against this from a strictly libertarian "govt shouldn't be in charge of it" but simply on the basis of fiscal conservatism, you need to give the nod to this plan over the current method at the least.

    Again, be freaking reasonable Reason. Nothing but garbage the last couple articles I have read. Is it a sin to be impartial anymore?

  • Sevo||

    wearingit|7.30.18 @ 9:28PM|#
    "Fair to look at the 32 trillion dollar cost. What is not fair is leaving out that it saves about 300 billion over the current system...."

    Proven to be a fucking lefty ignoramus; read if you have time to waste.
    Fuck off, slaver

  • Cyronic||

    Pretty sure the article pointed out that this $32T estimate assumes that the Medicare-for-All proponents are correct about their administrative savings. In reality, as with all government programs, this likely will not be the case. Your $300B savings will likely turn out to be trillions in bureaucratic waste, not to mention the major economic repercussions, the inevitable shortages, and even further inevitable price-fixing that will cause even more economic disruptions.

  • Presskh||

    Sanders is a fucking idiot in many ways, most notably in economics. The only thing I can give him credit for is his opposition to the Iraq War.

  • Jerry B.||

    Liberals should support a Libertarian platform that eliminates the income tax, so they can take the money that they would otherwise pay in taxes to support America's wars, ICE, and The Wall, and donate it to private charities that would pay the medical bills, rent, food bills, etc., of those less well off.

    I mean, Liberals would be happy to spend their own money to support the causes they champion, right?

  • Tony||

    It's almost like you aren't even trying to understand the point of a social safety net.

    You do it because it's good for you, not because you're a nice person. I don't like being around poor people, but I think government should feed and house them, because otherwise they might camp on my lawn.

  • Sevo||

    Tony|7.30.18 @ 10:51PM|#
    "It's almost like you aren't even trying to understand the point of a social safety net."

    It isn't even 'almost' like you have no grasp of reality.
    Fuck off, slaver.

  • MarkLastname||

    You could try and save up your own money or buy your own insurance because it's good for you. You know, instead of forcing younger people to buy you things they won't be getting when they're old economic growth will have ground to a halt by then.

  • vek||

    Or if you stop giving them money to not work, and enforce vagrancy laws, they might just... I dunno... Get a fucking job because they don't want to starve to death? That seemed to work pretty good throughout all the rest of human history before we turned into a bunch of bleeding heart pussies who encouraged laziness.

  • JunkScienceIsJunk||

    It didn't work all that well. Our "die of starvation" rate is currently at historic lows. So the "safety net" idea is probably keeping some people form dying. Given that there is a very clear causal relationship between poverty and crime, Tony's point is correct -- dealing with the problem of poverty in a constructive way will make YOUR life better too by improving safety, commerce, and making the country a generally better place.

    But I think libertarianism does a better job of addressing poverty than progressivism. Amid Tony's calls for helping the poor are also calls from his side for restricting what the poor are allowed to do, arranging the economy in a way that intrinsically favors people from wealthy backgrounds, not allowing the poor access to certain vehicles that promote socioeconomic mobility, and ultimately using police forces to round them up. (I'm picking on Tony here, who as best as I can tell isn't one of the "lock 'em up" liberals, although I'd argue he's in the minority on that one...)

  • vek||

    "dealing with the problem of poverty in a constructive way"

    Agreed. Also agreed that libertarian solutions are better. The fact is before the government got into the welfare business, it wasn't much/any worse for the poor than today... The difference was that it also saved an obscene amount of tax payer money, and encouraged work versus sloth.

    This has always been my thinking:

    Until the great recession we had a sustained labor force participation rate that was between 65-67% for decades. Add in the 4-5% that were simply between jobs at any given time and you have about 70% of the working age population working at any given time. Of the 30% who weren't a HUGE percentage of them were not working on purpose. Stay at home mothers, people who retired early etc. What percentage of those would you guess are the "permanently unemployable" so to speak? Not people who slack but work off and on, I'm talking the ones that NEVER work. 10%? 20%? 30%?

    I'd guess it's probably under 20%, but let us assume that it is that. So 6% of the adult population. A good chunk of them are probably mentally insane, or perhaps drug addicts of the bad variety, cripples.

    If we got rid of all government welfare of all forms, and freed up hundreds of billions a year... 94% of the population would be better off with all that money sloshing around in the economy. More jobs, probably higher wages, higher standard of living for all BUT those people.

  • vek||

    The ONLY form of welfare I think is possibly acceptable is dealing with mentally insane people, those that are so physically handicapped they can't work (being in a wheelchair don't count because there are plenty of jobs that need no legs, you gotta be quadriplegic), and perhaps the completely indigent elderly with no family to care for them. Family should be 1st up for all these though too. On a case by case basis one can determine if these few categories of truly needy should be put in institutions to care for them (held to higher standards of decency than in the past), or perhaps helped on the outside.

    But anybody who is physically and mentally sound should have zero welfare available. They will either get their shit together, as the overwhelming majority of people do, or if they DO turn to crime they can be dealt with in the criminal justice system. This will provide a better life for the other 94% of the population, and possibly even for the 6% we presently have trouble helping because we're spending so much subsiding sloth with people who ARE capable of taking care of themselves.

    Private charity can and would also help with a lot of issues. But the fact is we didn't have significantly more problems with this type of stuff before the rise of the welfare state, and there's no reason to think we would after getting rid of it again, ESPECIALLY not with all the extra economic activity that would come from putting that money back into peoples pockets.

  • vek||

    So I don't buy the premise that "It didn't work all that well." because it did. Crime rates way back in the day were comparable/lower than today for the most part. The 20th century was actually some of the worst times for crime EVER, and that was AFTER we created the welfare state. America in 1920 wasn't some hell scape where half the people were starving on the street or robbing people... We were the most affluent country on earth, but all people were a lot poorer back then. REAL poverty today is basically non existent except with those that refuse to work or can't work because of physical/mental issues.

    If the economy had all that extra money sloshing around only the completely worthless would not be doing fine economically, and they just have to be dealt with as criminals or wards of the state as appropriate. Not everybody is helpable, this is a fatal flaw many people have in their heads. Some people are simply a lost cause due to mental problems or whatever. So I say do what is right for the 94% of the population, and then deal with the problematic people as an isolated problem, which is what it really is.

  • vek||

    But there is no reason to be subsidizing housing so people can live in nicer neighborhoods than they should be able to afford, food stamps, etc etc etc etc. The extra cash in everybody's pockets would probably solve most of that on its own anyway. If there were any real down sides for any working person, which I don't think there would be, that would be more than offset by the gains for the vast majority of the population.

  • ||

    Is this an actual quote from Trotsky?

  • Unable2Reason||

    No ass wipe in government ever says that lower administrative costs are purchased by foregoing due diligence. You know, what any jackaninny would do if it was his own money he was spending.

  • Gilbert Martin||

    "No ass wipe in government ever says that lower administrative costs are purchased by foregoing due diligence."

    Which is why the federal government wastes $125 billion every year on improper payouts on entitlement and welfare programs.

  • Myk||

    $32 Trillion for 10 years? The CDC says we spent $3.2 trillion on healthcare in 2015.
    My medicine that was billed at $24K in 2016, is billed at $36K in 2018. That's quite a bit of inflation to add to 2015's $3.2T. According to my medicine that 2015 CDC number should be over $4.8 trillion in 2018.
    I bet if the govt actually pays its bills on time (yeah right) the lack of no-pays being passed on to paying customers by hospitals would save even more than $1.6 trillion Reason estimates.

  • Enjoy Every Sandwich||

    I just love the part where the progs claim that the government will be more efficient. The government is NEVER more efficient. If the government is put in charge of healthcare, in 20 years they'll be giving cancer patients a couple of Tylenol and bragging about how advanced our healthcare system is.

  • Echospinner||

    The government is in charge of healthcare and expenditures and has been for decades.

  • ||

    "Of all the ways of making decisions, one of the most ridiculous is putting decisions in the hands of third parties who pay no price for being wrong. Yet that has been one of the most fashionable -- and most disastrous -- methods used in this century" - Thomas Sowell

  • I am the 0.000000013%||

    First question on the intake form.

    Are you a Republican or Libertarian?

  • Whorton||

    Gawd daum. . .

    That man is an idiot!

  • scJazz||

    I am not in favor of Govt Healthcare however there are things about this article that I find... curious. I checked the statistics for the NHS in the UK and the cost ran 10% of GDP. After checking the numbers in this article the costs are over 15% of GDP. The obvious implication being that there is a lot of "air" in the numbers from this article. On quickly reviewing the progressive numbers there is an equally obvious lack of "air" in their figures. I wish there was a single clean un-tilted report that people could read to make a sound judgement rather than the politically skewed garbage that is available.

  • Echospinner||

    Fact is the emergency department is the most costly way to go. Nobody has come up with a scheme to get around that. The hospital tries by triage. They can have PAs and CRNPs to deal with less emergent issues in an urgent care track. That works and they are professionals but you are still not dealing with the bigger issue of preventative and primary care.

    Because the hospital takes every patient who shows up there is gross cost shifting going on. It does not cost $70 for a Tylenol. They will never get the $2000 or more they charge for the CT scan. We can just keep on paying on that basis. It is not free market and never will be. It is not a box of cornflakes.

  • ||

    We all know it will cost $120 trillion. Let's get real here, it will come out to 3 or 4 times more than the cost quoted.

  • Mark22||

    And our tribe has ... not a not a damn thing?

    Well, given your mix of platitudes and incoherent ramblings on the subject, it's not surprising that you were ineffective in making progress on this despite decades of trying.

    Leave it to the next generations and STFU.

  • JunkScienceIsJunk||

    He raises a fair point though (even if only by accident). Libertarians aren't strong on this issue because of the reliance on "charity" as the sole provider for the poor. The "dying in the streets" accusations that the democrats toss at republicans all the time apply to us even more.

    It's a difficult argument to win because even though we may be technically correct from a liberty standpoint, nobody else really believes that the poor should be left untreated. How should society deal with that? You won't find it in the LP handbook.

  • blondrealist||

    Libertarians covered by employer-provided health insurance (which is market distorting and tax subsidized) are sometimes weak on the issue because they have little or no first-hand experience dealing with the individual health insurance market. Before the ACA, the individual insurance marketplace was a challenge unless the consumer was young and healthy. Insurance companies didn't just turn away people with serious health conditions like cancer or diabetes. I have lots of faith in free markets, but health insurance does not fit well in the free market, without regulation.

  • Darr247||

    Sounds cheaper than the $900/month I pay now for insurance. Even if your work pays for it, they're probably paying that much for yours, too.

    How is it you all believe businesses will share the trillions of dollars in tax breaks they got, but not the trillions they'll save by not having to pay your health insurance bills?

    If we have to pay more in taxes, a business's share should match as well (it will still be cheaper for them than paying for ALL of your health insurance).

  • blondrealist||

    Total health care spending in the USA was about $3.3 trillion in 2016 - which was around 17.9% of GDP. Our system is already very expensive, and will likely get more expensive. With no changes to our current system, aggregate health care spending in the USA will likely exceed $32 trillion over the next decade. I don't care much for Bernie's single-payer proposal - and he seems to be doing a lousy job of trying to explain his belief that his proposal won't lead to increased health care spending - it will just spend the money differently - supposedly more fairly, leaving no citizens without health care. Again - I'm not pushing for his plan, just pointing out that no matter what, we are going to spend $30-40 trillion on health care in the next decade - and Bernie will deserve none of the blame.

GET REASON MAGAZINE

Get Reason's print or digital edition before it’s posted online