For decades, many liberals have dreamed of a universal health insurance system in which the federal government provides coverage to everyone and pays the cost. Known as "single-payer," it's modeled on programs in Canada and Britain, among others, as well as Medicare.
Now Bernie Sanders is making that idea a centerpiece of his presidential campaign. He unveiled an outline for "Medicare for All" on Sunday. And one thing is clear: It has all the qualities of a dream.
If Sanders has his way, private health insurance will be a thing of the past, replaced by "a federally administered single-payer health care program" that "will cover the entire continuum of health care." Patients will be free to choose their doctors, and everything will be simple and free, because there will be "no more copays, no more deductibles and no more fighting with insurance companies when they fail to pay for charges."
How would Sanders pay the $1.38 trillion annual price tag he puts on his model? He would raise marginal income tax rates, which currently top out at 39.6 percent, to 43 percent on households earning $500,000 a year or more, going up to 52 percent on those making more than $10 million. He would raise taxes on capital gains, dividends and inheritances.
He would also impose a 6.2 percent "income-based health care premium paid by employers" and a 2.2 percent income-based premium paid by households. But most people, in his forecast, would come out ahead because they'd no longer be paying for private insurance.
The abolition of copays and deductibles, combined with the promise of covering any treatment or medicine any patient wants, would make this program far more generous than Medicare. The first effect would be to stimulate even more demand for services. The second would be to prevent sensible limits on therapies. No system can be financially sustainable under such lavish terms.
Sanders, however, insists he can bring down our total health care spending by $6 trillion over the next 10 years. Don't bet on it. As Ezra Klein wrote on that website, the way single-payer systems curb expenditures is by "cutting reimbursement to doctors, hospitals, drug companies and device companies" - which inevitably means denying some treatments to actual patients. Canada and Britain are notorious for rationing care through long waits. One result, says the Fraser Institute, a free-market think tank based in Vancouver, is that 52,000 Canadians went abroad for treatment in 2014.
The bold new plan Sanders offers is really a variation on an old theme: The government will provide ever-more health care to more and more people at a lower cost. It ducks the painful problem of how much health care we can afford and pretends it can be financed without any real sacrifice by ordinary people.
He and his supporters are entitled to dream. But there comes a time when you have to wake up.
REPRINTED FROM THE JACKSONVILLE DAILY NEWS
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