This is what I came in here to mention. The same study found that Medicare for all was actually cheaper than the current “system”.
In any event the money is there. We have money when we need to fight wars; we have money when we need to bail out agribusinesses and banks; we have so much money we are willing to give up trillions to cut taxes on corporation and billionaires. There is always money. The question is what our priorities are to do with that money.
And of course we do that now in the existing UHC for old people.
Oh, wait, we don’t.
I thought the death panel crap was over. But you still bring it up.
Only for people under 65.
Better is a matter of perspective, I suppose. Covering everyone at theoretically higher levels of care is a win (the proposal expands guaranteed coverage in certain areas). However, moving from a cost of 22%-ish of GDP down to 21.0-21.5% of GDP (2022 projections) is nothing to brag about when other OECD nations are sitting at 10-12% of GDP. The U.S. is rich, but not so rich that we afford to spot them 10% GDP and still remain competitive with them.
You add to this the fact that there will likely be substantial borrowing required to cover one-time transition costs. And of course, all these projections are just back-of-envelope-style calculations filled with huge uncertainties to begin with, and you’re taking a substantial risk to save 1% (+/- whatever the uncertainties are) GDP versus baseline.
Under something like this, a lot would hinge on whether the framework itself would lend itself to efficiency improvements and cost savings through data-driven practices. The proposal does pay a lot of attention to data collection, data analysis by qualified professionals, and regular review and improvements on practice guidelines (what treatments to cover and what treatments “aren’t worth it”). So it’s entirely possible that under such a framework, costs could gradually be dragged down over the long haul far beyond the initial 0.5%-1.0% of GDP cost reduction, and that the populace would generally accept the judgments of the HHS governing body.
Myself, I’m skeptical; Congress tends to be great at passing benefits expansions, because hey, who doesn’t like more stuff ? (I’m looking at you, Medicare Part D). I’m less impressed with their ability to implement reforms/reductions. I think it’s entirely plausible that under the proposal, we’d transition, start to cover everyone, get a modest long-run cost reduction, and that’d be the end of the cost reduction reforms. And I don’t consider 20%+ GDP for healthcare to be particularly desirable or long-run sustainable.
I think we need something much more outside-the-box than Medicare for All, even if it would be a substantially tougher sell politically.
In light of the greater effectiveness of single payer systems in other industrialized nations, I can’t help but think that there is something else, another issue, that worries our domestic opponents of the concept. But they won’t really come out and tell us what it is.
This is innumerate. The Iraq war cost 1.9 trillion over 7 years. The agribusiness bailout is going to cost 13 billion dollars, the corporate tax cut is projected to cost 220 billion a year. Under this rosy scenario medicare is supposed to cost 3.2 trillion a year, every year. For comparison WW2 cost the US 4.1 trillion in total.
This is like saying we have money for shoes, we have money for snacks, we have money for video games, we can find money for a gold plated Rolls Royce.
Ro Khanna on Twitter (congressman from CA):
Compared to $49T, it looks like a bargain.
You don’t think that a price tag that would necessitate doubling the amount of tax collected to be a plausible reason?
Well, the question is really more like, “The nation is going to spend >$3 trillion on health care annually, is it better overall for employers and employees to be on the hook for that bill, or better if the government takes responsibility for it so businesses and workers don’t?”
This is remarkably different than the military spending $1.9 trillion on the war in Iraq. Had it not been for the war, average Americans would not have spent that money on their own.
Yes, because we know that a totally government-run system will feature far more inexpensive and efficient administration than the private mess we have now.
I also look forward to the day when I don’t have to contemplate arguing with private insurers over coverage, and can instead depend on sympathetic and timely responses from government health care administrators.
I’m all in on Bernie’s plan. Especially since I won’t be practicing medicine too much longer, and the 40% cut in provider payment rates on which the $32 trillion price tag depends* won’t affect me, unless providers decide they’re better off doing something else besides medicine.
*the Mercatus Center projections say the Medicare For All plan would cost $38 trillion without those provider cuts.
I wasn’t aware this point was particularly controversial; the controversy usually surrounds the exact size of the benefit and the amount of administrative waste currently in the U.S. system. Since they are opposed, Mercatus is using smaller consensus numbers for the administrative cost savings, whereas someone who is in favor of the plan would be tempted to use the larger cost-saving numbers. But the idea that standardization and administrative homogeneity reduce inefficiency and cost is hardly a novel concept. The data comparisons for administrative costs among various systems bear this out generally, even if the various comparisons are not precisely apples-to-apples comparisons due to the varying structures.
The 800-lb gorilla is that any universal healthcare is only going to work if there are fewer healthcare workers getting paid less. We can talk about inefficiencies in the system, but inefficiencies typically mean that someone is getting paid to do something that doesn’t need done, so their job is going to get axed. If we pulled our healthcare spending in line with what other countries are paying (which seems to be almost required if we’re going to keep such a system afloat) we would end up losing a minimum of 5% of our economy and likely closer to 7%. That’s 1-1.5 trillion dollars. Some of that would be savings resulting from health insurers no longer making a profit, but their profit is a drop in the bucket compared to how much we would have to cut. There’s no politician in the world that wants to bite that bullet. Saying, ‘there will be fewer doctors and nurses and they’re going to get paid less.’ is not exactly a big ballot box winner and ultimately that’s what it’s going to have to come down to. You’re not going to milk 1.5 trillion dollars from the administrative side of the house, just isn’t possible.
We apparently haven’t bridged the gap in understanding that single payer doesn’t entail $3 trillion more in additional annual expenses.
It* is* a hit piece, from a trickle-down/small government True Believer. Table 1 from Blahous’ paper reallly says it all (page 4 of the PDF), because it assumes administrative cost savings of $83 billion per year. To quote myself, that figure is only half of US wasted administrative spending:
Blahous attempts to justify his administrative cost calculations starting on page 14, but none of his arguments are very convincing. For example, he cites existing Medicare administrative costs and claims they will go up. This is nonsense, because Medicare will no longer have to determine if it is the primary payor in every single transaction as it does now.
Would enough healthcare professionals leave the business if their pay was reduced to make healthcare scarce?
I’ve noticed a group of physicians who support medicare for all and here’s an article about medical students who support it.
Physicians for a National Health Program
We are America’s future doctors. We support a Medicare-for-all health system
From your experience, are these doctors and health care professionals not in the mainstream in their views about Medicare for all?
I’m curious about this part. Why would the general public be unhappy about healthcare professionals making less money if it allows them to get healthcare, unless of course, they’re a healthcare professional?
Well, a lot of people have apparently signed on to the idea that turning over health care administration to a central government entity/entities will save a whopping amount of money; for me there aren’t enough :dubious::dubious::dubious: to express the likelihood of this happening.
Remember when universal adoption of the electronic medical record was touted to not only improve care, but save $80 billion or more a year in health care costs? Based on the experiences I’ve heard about (including deficient/non-optimally communicating systems that have to be maintained or replaced with the help of expensive IT help, not to mention the misery of spending hours a day feeding info into these systems (or hiring scribes to do the labor), this hasn’t quite happened yet.
Meantime, in addition to discussing Sanders’ plan, how come we’ve forgotten about Paul Krugman’s idea of promoting the V.A. system as a model for cost-efficient patient-centered health care in America? Cynics might point to the subsequent and ongoing scandals in the V.A. system, but that’s just “cognitive dissonance” 
But, again, the current system costs more per year. Plus you buy a bomb, you deploy that bomb and it explodes. You have nothing left. You spend trillions on health, education and infrastructure, those pay dividends down the line. It’s a cliche to say they are an investment but they are.
Let’s run through the American exceptionalism that makes it so impossible for us to do what others do routinely.
I’m not really sure who the “lot of people” you’re referring to are, but certainly the people doing these types of analysis aren’t saying such things at all. Even the most optimistic projections I’ve seen for some universal healthcare proposals put potential administrative cost savings in the $150 billion region; a nice chunk of change, but hardly “a whopping amount of money”. The claim isn’t “turning over health care administration to a central government will save a whopping amount of money”; there’s nothing magical about government. The claim is “standardizing administrative practices saves money.” Government administration is just one way to bring about a standard; there are a number of mechanisms currently employed in various systems to enforce health care standards through regulation without actually having the government take over the administrative effort wholesale.
EHR is just a case in point. If you don’t standardize and have interoperability, your system doesn’t do much for you.
In these types of analyses, administrative savings is just one piece of the puzzle. Equally important savings comes from proposed changes to curtail the use of low-value treatments through analysis of patient outcome data, bargaining down drug prices, bargaining down provider prices, and avoiding duplication of services provided.
No kidding. Does anyone remember how Americans used to make fun of the Soviet system of shopping: line up here to get in line; then go to the other line to make your order; then another line to pay; then another line to stamp your ration book; then another line to get your product; etc.?
I’m sure there were many good communists who would say, “But we have the best performing system of lines! If we went to market economy, all those clerks would be out of job! Article 52 of Five Year Plan dictates that this inefficiency is necessary for maximum good!”
Well, our health care system is just as retarded as the Soviet system of buying a can of tomatoes. Except that there are an oligopoly of health insurance providers, each with their own crazy rules, forcing sick people through crazy different lines even for the same doctor’s office or hospital. It’s nuts.