Bernie Sanders Still Can’t Explain How He’s Paying For ‘Medicare For All’

Bernie Sanders Still Can't Explain How He's Paying For 'Medicare For All'.

by Mark Hemingway · April 16, 2019
Appearing at a Fox News town hall in Bethlehem, Pennsylvania on Monday, Vermont senator and socialist presidential candidate Bernie Sanders turned in a fiery and combative performance. One moment particularly seems to be generating a lot of excitement.

After an audience member asked about his “Medicare for all” health plan, which would require eliminating private health insurance, Fox host Bret Baier decided to poll the audience to ask if they would prefer Bernie’s plan to their existing health insurance. Here’s what happened:

Bret Baier just polled the Bernie Town Hall audience who would be willing to switch to #MedicareForAll. It backfired spectacularly. pic.twitter.com/dQJ9gfQ137

— jordan (@JordanUhl) April 15, 2019

This is a bit unfair to Baier, since it assumes he asked the question in bad faith, rather than knowingly asking the politically diverse crowd Fox assembled for the event their opinion on the matter. Further, it doesn’t really tell us much that a room half full of Democratic voters and Bernie supporters prefer some imaginary, aspirational future where the government pays for health care and there are minimal problems, as opposed to the warts-and-all reality of what we have now. (Certainly, it’s appealing enough that four other Democratic presidential candidates have chosen to co-sponsor his recently introduced “Medicare for all” legislation in the Senate.)

That’s especially true since Sanders hasn’t done a good job of explaining “Medicare for all,” to put it mildly. Asked about the specifics of his plan, Sanders employed the tried and true three-step explanation for how it works.

Step one, point out that the United States is the only “very highly developed” country without socialized health care and note that U.S. per capita health spending is much higher than that in these other countries. Make sure you do this without noting the problems inherent in the way these other countries ration lifesaving treatments (and even prevent you from leaving the country to seek potentially lifesaving treatment, presumably just to make some stupid nationalistic point about how great it is that everyone is trapped in the same system together). Also, under no circumstances note that these other countries often have vastly inferior medical technology and infrastructure–the average wait time for an MRI in Canada can be longer than five months, which is unthinkable here.

Step two, elide over all the details of how to implement a socialized system that addresses the size and diversity of American health care, which is radically different than the challenges faced by much smaller and more homogeneous European countries with supposedly superior care. Most importantly, also elide over the fact that the socialized health care system we have that’s supposedly so appealing, Medicare, is a money black hole with trillions in unfunded liabilities that is the single largest driver of our enormous debt that threatens to precipitate a republic-destroying financial crisis.

Step three, after having said nothing particularly illuminating or specific, bask in the glory of being a radical reformer that dares to imagine a future where greedy insurance companies are put out of business by a selfless and incorruptible federal government.

That was roughly the template Sanders followed during his Fox town hall, and from the video above you can see he scored debate points on health care. (Or at least, Vox, HuffPo and much of the left-of-center Twitterati seem to think so.)

But if you were listening, Sanders made some telling admissions. “You’re gonna pay more in taxes but your health care will be cheaper,” he said. For a long time now, Sanders has owed us an actually detailed explanation for how our health care is going to get cheaper under “Medicare for all,” and it hasn’t been forthcoming.

The Associated Press summed up a study done by the Mercatus Center last year this way, “Sen. Bernie Sanders’s ‘Medicare for all’ plan would boost government health spending by $32.6 trillion over 10 years, requiring historic tax hikes.” Of course, Bernie Bros would protest that the Mercatus Center is a libertarian think tank not predisposed to give Sanders’s plan a fair shake. But what about The New York Times?

When Sanders was running for president in 2016, New York Times domestic correspondent Margot Sanger-Katz kicked the tires on Sanders’s “Medicare for All” plan he proposed then and concluded, “Bernie Sanders’s Health Plan Is More of a Tax Plan“:

[T]he plan … was full of details about the taxes that would be collected to finance it. The plan would charge a special income tax, called a premium, increase payroll taxes and raise a variety of taxes on high-income Americans, including income and capital gains taxes. Those are big, specific changes, worthy of detailed coverage. Missing, however, were more than a few sentences about how the proposal would change the health care system in the United States.

Further, “Medicare for all” doesn’t have much to do with Medicare as we know it:

But the program he describes isn’t an extension of the existing Medicare program, which provides health insurance for older people and the disabled. Medicare includes premiums, co-payments and deductibles, and excludes coverage for long-term care or dentistry. A lot of important details have been left out. Here are some things it doesn’t say: What would the new system pay doctors and hospitals for their services? How would it decide which medical treatments it should and shouldn’t cover? What strategies would it use to contain health care costs and keep the system affordable? Who would make the decisions, big and small, about how the program would work?

Finally, Sanders’s own campaign economists couldn’t explain to Sanger-Katz how his plan was supposed to work:

I spoke with Gerald Friedman, a professor of economics at the University of Massachusetts at Amherst, who provided the campaign with estimates of the program’s cost. … Mr. Friedman calculates, for example, that the cost of physician services in a single-payer system could be lowered by 10.7 percent — his estimate of how much doctors currently spend on billing and administration staff that they would no longer need. I asked him how the payer would get to that number — would the government pay lower prices for treatments, or change which treatments it paid for, or switch doctors to a system in which they earn government salaries?

He couldn’t say with certainty. ‘The pleasure of being an academic is I can just spell things out and leave the details to others,’ he said. ‘The details very quickly get very messy.’

Well, that’s quite an admission. But in the more than two years since Sanger-Katz tried to understand how Sanders’s plan worked, it seems everyone in Sanders’s orbit, himself included, has been leaving the details to others. After being embarrassed in the pages of The New York Times in 2016, apparently they learned nothing.

Astonishingly, when the AP reported on the Mercatus study last year, Sanders wasn’t even able to begin to refute the report’s conclusion that his plan was financially unsustainable. Why? “Sanders’ office has not done a cost analysis, a spokesman said.”

His recently proposed “Medicare for all” legislation doesn’t much improve on prior attempts to flesh out how health care will be administered in a cost-effective manner, even as it’s full of tax hike proposals such as 70 percent marginal tax rates on income over $10 million, 77 percent estate taxes on the rich, and taxes on big banks. Even the liberal outlet Vox once again admits the “plan has lots of details about what single-payer would cover. It has less information on how to pay for it.”

In the end, Sanders doesn’t have a health care plan, so much as a branding strategy for one. Medicare, despite its fiscal unsustainability, is very popular. So calling government-run health care “Medicare for all” is a stroke of genius, insofar as it makes the American public more receptive to socialist ideas. That’s why other Democratic candidates are happy to associate themselves with “Medicare for all” as a slogan, but appear to be distancing themselves from the actual policy.

Kamala Harris may be co-sponsoring Sanders’s legislation, but ultimately she “backs many incremental, go-slow plans that aren’t as radical and add up to something more like ‘Medicare for more’ or a strengthened version of Obamacare,” notes Politico. Similarly, another candidate and Senate co-sponsor, Elizabeth Warren, has taken a similarly less radical approach, saying she’s “open to different paths” to getting “Medicare for all.” In reality, her plan is more like the “ACA 2.0.”

In a lot of polls, Sanders is the frontrunner for the Democratic nomination. He cannot be allowed to offer a radical plan he freely admits will cause 180 million Americans to lose their existing health care coverage and one where credible estimates suggest “doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan,” and not bother explaining how it works.

Yet he’s gotten away with it for three years. The press, as well as his competitors in the Democratic primary, need to grow a spine and demand some real answers here.

The Federalist · by Mark Hemingway · April 16, 2019

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