Why Bernie Sanders' Single-Payer Push Is Great Policy and Even Better Politics
A few important things to be clear about.
Bernie Sanders unveiled his latest version of a Medicare-for-all plan on Wednesday, to a highly unusual level of media attention and support within the Democratic Party. A third of the party's Senate caucus have come out as co-sponsors — although, unsurprisingly, neither Chuck Schumer nor Nancy Pelosi are backing it yet — and it looks likely that more will sign on soon.
The plan is extremely generous — indeed, much more so than many peer countries. But that only makes it great policy and better politics.
So first, the details: The plan would be phased in over a period of four years. In the first year, traditional Medicare would be expanded to cover dental, vision, and hearing aids, as well as people over 55 or under 18, while others would be able to buy in if they wish. In the second year, the age qualification would be lowered to 45, in the third year to 35, and then in the fourth year, everyone remaining would be included.
This upgraded version of Medicare would also be a lot more generous in terms of access. There would be no cost-sharing, except for prescription drugs. It is, as Paul Waldman argues, probably best understood as an opening bid — a symbolic maximal demand rather than the usual pre-compromised Democratic fare.
Sanders later released a sketch of a financing plan, which lays out several options to reduce costs and raise revenue, though it does not decide which is best. A more detailed discussion will inevitably have to be part of any Medicare-for-all bill. But there are some important things to be clear about. When talking about expanded public health programs, writers and analysts tend to mention "costs" in a way that can be rather misleading. Many skeptics cite Vermont, for example, which balked at the tax increases necessary to pay for a single-payer plan in the state.
Imagine a developing country that is just getting wealthy and organized enough to think about setting up a universal health-care system. There, costs would be a very important question, because a lower-income country can easily run into economic constraints. Therefore, one would have to carefully balance the generosity of the program against the country's ability to mobilize real resources — doctors, nurses, drugs, and so forth.
The United States, by contrast, is very rich, and already dedicates way more than enough resources to set up the world's most generous health-care system, and a lot more besides. We spend $3.2 trillion per year — literally twice as much as the OECD average as a share of the economy. We pay enough in health-care taxes alone — that is, the government revenue that goes to Medicare, Medicaid, the VA, and a few other things — to cover a Canada-style Medicare-for-all system for the whole U.S., and then that much again in private money. In other words, if we could simply copy-paste Canada's universal health-care system into America, taxes would actually go down.
All that means is that America doesn't have to worry much about costs; it has to worry about allocating existing spending properly. We already have a gigantic pool of resources dedicated to health care — about half private and half public. We just have to adjust that spending so it can support a single-payer system.
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