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Single-payer healthcare: Bernie Sanders’ bill will test whether Americans are ready


Michael Fleshman | CC BY SA 2

John Burger - published on 09/25/17

Opponents speak out against government "takeover" of healthcare.
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It wasn’t long ago that the idea of “socialized medicine” was a nonstarter among most Americans, eliciting repugnance at the thought that any aspect of the United States could be “socialist.”

Now, one U.S. senator has made the unthinkable thinkable. It still may not be palatable, however.

In the midst of Republicans’ continuing efforts in Congress to dismantle the Affordable Care Act—the latest attempt at which, a proposal by Senators Bill Cassidy of Louisiana and Lindsey Graham of South Carolina, faces an uphill challenge in a vote this week—Sen. Bernie Sanders, the Independent from Vermont who ran for president in 2016, has introduced something he calls Medicare for All. With 15 cosponsors in the Senate, the bill is the closest the United States has come to entertaining a proposal for universal “socialized medicine,” or as most would call it today, a “single-payer healthcare system.”

Rep. John Conyers also introduced a similar “Medicare for All” bill, cosponsored by 117 House Democrats.

“In a single-payer healthcare system, the government pays for all medically necessary service for all citizens, regardless of income or ability to pay,” explains the Acton Institute, a think tank promoting “a free and virtuous society characterized by individual liberty and sustained by religious principles,” according to its website. It explains that the U.S. actually already has a single-payer system. It’s called Medicare, though it’s only for persons over the age of 65 and those under that age who have have specific disabilities.

Sanders’ proposal, which most people agree has no chance of passing in the current political climate, would broaden that eligibility to “all individuals residing in the United States,” including its territories. Rather than paying premiums to an insurance company, an individual would simply sign up. According to Sanders’ bill, Medicare would cover all medically necessary services, including at least the following:

(1) Primary care and prevention

(2) Approved dietary and nutritional therapies

(3) Inpatient care

(4) Outpatient care

(5) Emergency care

(6) Prescription drugs

(7) Durable medical equipment

(8) Long-term care

(9) Palliative care

(10) Mental health services

(11) The full scope of dental services, services, including periodontics, oral surgery, and endodontics, but not including cosmetic dentistry

(12) Substance abuse treatment services

(13) Chiropractic services, not including electrical stimulation

(14) Basic vision care and vision correction (other than laser vision correction for cosmetic purposes)

(15) Hearing services, including coverage of hearing aids

(16) Podiatric care

Private health insurance coverage would still be legal for benefits not covered by the bill, such as for cosmetic surgery or other services and items that are not medically necessary. Healthcare providers’ fees and salaries would be determined by the government after “close consultation with the National Board of Universal Quality and Access and regional and State directors,” Acton explains. The prices to be paid each year for covered pharmaceuticals, medical supplies, and medically necessary assistive equipment would be negotiated annually by the Medicare for All Program.

Because Sanders believes the current healthcare system is designed to “provide huge profits to the medical-industrial complex,” his bill would only allow public or not-for-profit institutions to be participating providers. “Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor-owned,” the bill says.

The program would be paid for mostly by increased taxes, which would include:

  • Increasing personal income taxes on the top 5 percent income earners.
  • Instituting a “modest and progressive” excise tax on payroll and self-employment income.
  • Instituting a “modest tax” on unearned income.
  • Instituting a “small tax” on stock and bond transactions.

Predictably, introduction of the bill has elicited responses from both proponents and opponents.

“It would elevate the medical-services industry to a dangerous height in our government and undermine the republican principle that the people, rather than special interests, should rule,” wrote Jay Cost, a contributing editor of The Weekly Standard and the author of A Republic No More: Big Government and the Rise of American Political Corruption.

“Imposition of a government health-care monopoly—be it in the form of the Medicare fee-for-service system, the British National Health Service or the Canadian health system—has certain economic features in common,” wrote Robert E. Moffit, a senior fellow in The Heritage Foundation’s Center for Health Policy Studies. “First, such a system will rely on broad-based taxation, usually in the form of some sort of payroll tax … Second, the program costs will surely outrun the official projections,” driving up tax rates.

Sanders himself, in an op-ed in the New York Times, asked if America was ready to “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?”

“Americans should not hesitate about going to the doctor because they do not have enough money,” Sanders wrote. “They should not worry that a hospital stay will bankrupt them or leave them deeply in debt. They should be able to go to the doctor they want, not just one in a particular network. They should not have to spend huge amounts of time filling out complicated forms and arguing with insurance companies as to whether or not they have the coverage they expected.”

He said that in 2015, the United States spent almost $10,000 per person for health care. Canadians, Germans, French and British spent less than half of that, while guaranteeing health care to everyone, he claimed, adding that these nations have higher life expectancy rates and lower infant mortality rates than the U.S. does.

In a tracking poll in July, the Kaiser Family Foundation found 53 percent of respondents in favor of having all Americans get their health insurance from the government, with 43 percent opposed, AP reported. Opposition climbed to 60 percent when people were asked to consider that such a plan would call for higher taxes for many.

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