September 15, 2017

Time for Single-Payer Health Care? Nope

Bernie Sanders once warned it would “bankrupt the nation.” Now he’s proposing to do it.

“If we expanded Medicaid [to] everybody … we would be spending such an astronomical sum of money that, you know, we would bankrupt the nation.” —Bernie Sanders in 1987

During the original debate about what became known as ObamaCare, there was a small but vocal faction in the Democrat Party that believed America needed to go further down the road toward a single-payer health system. Health care is a right, they argued, and America was the one industrialized nation without a government-run system.

While conservatives and commoners alike argued that Americans weren’t interested in the long waits and rationing that come with “free” health care, congressional Democrats flirted with the idea of introducing the “public option” to ObamaCare. Ultimately, they relented to the demands of moderates within the party and attempted to work within the existing system of health insurance. Their contribution was to instead make having insurance mandatory, but available through a series of state-based exchanges while expanding Medicaid eligibility into the working class. Surely, they promised, this would allow practically everyone to have the means to pay for their health care.

Nearly four years into full ObamaCare adoption, though, we’ve learned two things about the program. First, it doesn’t work as intended because insurers continue to ratchet up their rates and deductibles or drop out of the market, leaving large and mostly rural regions of the country with one or no insurance providers. But we’ve also learned that there are just enough popular parts of the laughably named Affordable Care Act, just enough people who will scream bloody murder about the loss of their precious entitlement, and just enough media to find every would-be “victim” of losing mandatory coverage to frighten Republicans from repealing it — this despite their biannual electoral ritual of promising to rip out ObamaCare “root and branch” if we’d just hand them the keys to the government. Thus, ObamaCare has now become the accepted “floor” for government involvement in health care.

With that background in mind, “progressive” Democrats — led by the ostensibly independent Bernie Sanders — are more comfortable bringing the idea of a single-payer health care system back into the debate. On Wednesday, Sen. Sanders’ New York Times op-ed announced his introduction of legislation to eventually put all Americans under the Medicare program. As one would expect, it’s chock full of the bromides we’ve heard from the radical Left for years.

Sanders asks, “Do we, as a nation, join the rest of the industrialized world and guarantee comprehensive health care to every person as a human right? Or do we maintain a system that is enormously expensive, wasteful and bureaucratic, and is designed to maximize profits for big insurance companies, the pharmaceutical industry, Wall Street and medical equipment suppliers?” (Never mind he helped to create that system by getting the government more involved.) Under the Sanders plan, Medicare would be expanded in the first year to add dental and vision coverage and eligibility increased to cover all children under 18 and adults over 55. Each year thereafter for the next three years, the age threshold would back up a decade or more until all were covered by the fourth year.

Sanders also warns, “Needless to say, there will be huge opposition to this legislation from the powerful special interests that profit from the current wasteful system. The insurance companies, the drug companies and Wall Street will undoubtedly devote a lot of money to lobbying, campaign contributions and television ads to defeat this proposal.” Rest assured, Bernie, that if you cut them a slice of the single-payer pie they’ll be right in line, leaving the rest of us to foot the bill.

But to Sanders, there are no passionate defenders of Liberty, only greedy corporate interests.

Strangely enough, the high price 1987 Bernie warned of is one thing 2017 Bernie doesn’t address in the op-ed, but as part of the package he released a summary of revenue enhancements needed to pay for the system. Much of the revenue comes from higher taxes on employers and individuals, with the obligatory homage to soaking the rich by limiting their deductions and other options to reduce their tax liability.

With the introduction of the single-payer bill, Democrats who want to establish their bona fides with the #Resist crowd are quickly climbing aboard. Potential 2020 hopefuls (and fellow senators) Elizabeth Warren and Kamala Harris Tweeted their support several days ago, while Sen. Cory Booker gushed on local TV, “I think health care should be a right to all.” New York’s Kirsten Gillibrand bragged about the inclusion of her public option in the Sanders bill, saying, “I was especially pleased to work with my colleagues to help write the section of the bill about letting every American buy into a not-for-profit public option, as part of the four-year transition period that leads to single-payer. This would create an affordable, public health care plan that’s available to any American to purchase through the already-existing insurance exchanges.” Shades of 2009.

Even more moderate Democrats like Joe Manchin from West Virginia (a state that recently saw its governor switch to the Republican Party) and Max Baucus from Montana (another deeply Trump-supporting state) are warming up to the idea. Single-payer “should be explored,” said Manchin, although he said he wanted more information about how it works in other nations first. Baucus, who is regarded as one of the principal architects of ObamaCare and an opponent of single-payer, now concedes, “I just think the time has come” for it.

The only people in the caucus who don’t seem enamored with the prospect of a single-payer bill are those in party leadership, who remember what happened at the ballot box eight years ago. Republicans won’t let them forget that easily.

It’s already been shown, though, that the bad idea of single-payer is a budget-buster at the state level. Late in 2014, Vermont Gov. Peter Shumlin dropped ambitious plans for a state-run system, citing cost concerns and not enough political will to raise the revenues needed, particularly an additional 9.5% income tax coupled with an 11.5% increase in the payroll tax. A similar story played out in California earlier this year, with the state senate passing a proposal estimated to cost the state $400 billion annually. But to the dismay of proponents who considered his betrayal a stab in the back, Assembly Speaker Anthony Rendon put the kibosh on the bill, which he called “woefully incomplete” with “potentially fatal flaws.” The most fatal flaws may be the fact that California’s proposed single-payer system would triple the state budget and require a 15% payroll tax to make up part of the cost.

Single-payer as expressed by the “Medicare for All” movement is one of those things that sounds great until one digs into the devilish details. Considering that doctors are more and more reticent to take Medicare patients, and that the program is on course to run itself out of its Part A trust fund a dozen years hence, this scheme may be the opening push to “fix” overall health care just like we “fixed” the issue of the uninsured with ObamaCare.

As usual, the government is like the drunk looking for his car keys under the light not because it’s where he left them but because it’s where he can see. A system that was functional a decade ago is now dysfunctional, but we’re supposed to trust the people who thought they had it solved the last time. Pardon us if we’re not buying what they’re trying to sell.

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