Yesterday, a top-tier Democratic presidential candidate released new legislation that would uproot and supplant the entire American healthcare system -- and four of the other five Senate Democrats running for the White House endorsed the proposal. Bernie Sanders' revamped "Medicare for All" plan would actually end Medicare as it's currently constituted (the existing program is going insolvent, by the way), repealing the entire top-to-bottom status quo and replacing it with a sprawling, massively expensive, government-run regime. Nonpartisan experts estimated that Sanders' previous iteration of this plan would cost between $32 and $34 trillion over ten years, which would require giant tax increases on all Americans to cover the near-doubling of the federal government's annual budget. Due to new tweaks and "improvements" in this iteration of Sanders' plan, BernieCare 2.0's price tag will be even more astounding. Philip Klein reports:
Under the proposal, Sanders would transition the entire population to a new healthcare plan within four years. This is one reason why the term “Medicare for all” is a bit of a misnomer. The legislation doesn’t simply make the current Medicare program available to everybody, but it moves all Medicare beneficiaries out of the current program into the new government-run plan. His bill would effectively eliminate private insurance. Specifically it would bar the sale of private insurance, either directly to individuals or through employers, that duplicates any of the benefits of the government-run plan. Given that the government plan he envisions would cover such a wide array of benefits, it would leave little room for private coverage...Not only does the plan promise to cover benefits including hospital services, doctor visits, prescription drugs, mental heath treatment, and dental and vision care, but it promises to do so without out-of-pocket expenses. That is, the plan promises to eliminate premiums, co-payments, and deductibles.
Providing effectively unlimited health services to every American for free would naturally lead to an explosion in demand for services, but Sanders does not lay out how he expects the healthcare system to meet this new demand without causing significant barriers to access such as excessive wait times and difficulties obtaining appointments in the first place...Furthermore, one of the arguments in favor of a socialized system is that it allows the government to use its bargaining power to force medical providers to lower costs. But if Sanders were to put too much pressure on providers, it would drive some of them out of the business, exacerbating the access problems. Were he to put too little pressure on them and pay high rates, costs would soar. While all of this could have been said of previous versions of the Sanders plan, the latest iteration also adds a benefit that would cover home and community-based long-term care services.
Just to underscore the vastness of this expense (Bernie does not offer specific pay-fors, unsurprisingly), Klein writes: "The previous, less generous, version of his plan was so costly that doubling projected corporate income tax collections would cover just over one-tenth of its cost." Uncle Sam could double corporate income taxes, reap all of the expected revenues, and still need to find ways to pay for 90 percent of the program. Of course, such a large tax hike on American companies and job creators would have terrible economic effects, and businesses would find ways -- such as moving assets overseas -- to avoid the punitive new rates. Also, this piece of the analysis doesn't even devote much attention to the inevitable government rationing, increased wait times, and inferior care aspects of socialized medicine. Nor does it mention the fact that House Democrats' version of this bill would, by their own admission, eliminate between one and two million American jobs.
Plus, as Klein mentions, the Sanders-mandated, government-supremacist system would effectively outlaw private coverage, throwing nearly 180 million Americans off of their plans (with which they're overwhelmingly satisfied), and forcing them into a one-size-fits-all, no-choice bureaucracy. Senators Kamala Harris, Cory Booker, Elizabeth Warren, and Kirsten Gillibrand have all signed onto Sanders' bill. Bernie has also signaled that, one way or another, he'd want to pass single-payer healthcare -- the remaking of one-sixth of the US economy, with deeply personal ramifications for every single citizen -- with a simple majority vote, bypassing the legislative filibuster through unprecedented means:
In statement, Bernie Sanders explains how he’d tackle Medicare For All through reconciliation. It gets into weeds but is a BFD on par with ending filibuster: Basically he’d instruct VP to overrule any advice from the Senate parliamentarian that M4A provisions violate the rules. pic.twitter.com/WwAXvO7xil
— Benjy Sarlin (@BenjySarlin) April 10, 2019
Appearing on Special Report with Bret Baier last night, Senate Majority Leader Mitch McConnell slammed the misnamed "Medicare for All" legislation, importantly noting that even watered-down or supposedly "moderate" alternatives like a 'public option' would have the consequence of the State crushing private insurance through phony tax-payer-funded "competition" -- all with the end goal (I suspect that video may get a lot of play over the coming year-plus) of single-payer:
It ought to be called ‘Medicare for None.’ Because as the set-up piece pointed out, 180 million Americans would lose their private health insurance, that many of them have negotiated for at work. Medicare itself -- that current recipients have been paying into all these years -- would be completely drained by adding all of these additional people...even those who are skeptical about it like Senator Klobuchar are saying a public option. Well, that is not much different because if you have a public option, I guarantee the public option would also drive all the private insurance companies out of business.
McConnell advocated what he called "niche" fixes to improve the problematic realities of Obamacare (especially on lack of affordability, which has always been the "Affordable" Care Act's fundamental failure), but pledged that next year would feature a battle over whether voters want a government-run system. Might that telegraph McConnell bringing Bernie's bill up for a vote, a la the Green New Deal? Democrats might again hide behind a wall of "present" votes, but that approach might be tougher to defend this time around. In the thick of a competitive electoral cycle in which much of the Democratic base wants single-payer healthcare, would Bernie Sanders and other Democrats running for president really refuse to vote to their own bill? This isn't an 'aspirational' resolution, or whatever, like the GND was. It's actual healthcare reform legislation that they've explicitly endorsed as a major plank of their electoral platforms.
For their part, Republicans (aside from developing some semblance of a real healthcare plan of their own) should request a Congressional Budget Office score of the Sanders/Harris/Booker/Warren/Gillibrand bill. Once they have an 'official' cost estimate in-hand, they should introduce companion legislation featuring extremely painful tax increases to illustrate the requisite pay-fors, then hold votes on both bills and let Democrats decide if they actually believe in the profoundly impactful and irresponsible policies they claim to favor.