Berniecare’s Medicaid for All

As the Republican effort to repeal and replace Obamacare withered on the vine, the self-described socialist senator from Vermont rushed to fill the political vacuum. Bernie Sanders’s Medicare for All Act of 2017 is a single-payer proposal that shamelessly attempts to harness the popularity of Medicare, the government insurance program for the elderly. But the system Sanders proposes would be more aptly described as Medicaid for all. It more closely resembles the expensive health insurance plan for the poor, which often provides inadequate coverage and pays such low fees to physicians that many refuse to participate.

Government-funded universal health care has long been a goal of the political left. But attempts to enact such entitlements at the state level have showed single-payer’s budget-busting reality. Vermont in 2011 approved a single-payer plan for the state that was supposed to take full effect this year. But legislators never worked out how to pay for it, and after intense efforts to make the program affordable, Governor Peter Shumlin declared it undoable financially and shelved the program. California progressives experienced a similar letdown this year, coming close to legalizing a single-payer plan only to learn that there wasn’t nearly enough gold in the Golden State to pay the tab.

It’s not clear why a national system would fare any better. Sanders, though, remains a true believer, and he is traveling the country exciting followers with a siren song of free universal coverage for everyone. In truth, while Sanders’s plan would probably bankrupt the country, its flaws go far beyond the price tag. Berniecare’s combination of spendthrift utopianism and authoritarian ambition would make us less wealthy, less healthy, and less free.

• Berniecare would create a “universal entitlement” to “free” health care. The bill creates a fundamental right to receive health care services while forbidding individual “cost-sharing, including deductibles, coinsurance, copayments, or similar charges,” with only minor exceptions. Covered services would be expansive, including “inpatient and outpatient hospital care; . . . ambulatory patient services; primary and preventive services; . . . mental health and substance abuse treatment services; . . . laboratory and diagnostic services; comprehensive reproductive, maternity, and newborn care; pediatrics; oral health, audiology, and vision services; [and] . . . rehabilitative . . . services and devices.” We’d have to buy our own aspirin, but not much else.
• Berniecare would obliterate the health insurance industry. The existing Medicare program is a single-payer system. But that isn’t all it is. Medicare requires substantial deductibles and co-payments, unlike Berniecare. Even so, Medicare trustees have warned that the program is on track for insolvency in 2028. Beyond that, a robust and competitive supplemental health insurance market exists to help beneficiaries pay for the “gaps” in Medicare coverage. Rather than being purely single-payer, Medicare is more accurately described as a hybrid system, with the government covering the bulk of beneficiaries’ medical costs but private insurers and beneficiaries paying for the balance.Sanders’s plan would not only destroy Medicare’s hybrid system but would obliterate the health insurance industry, including coverage as a benefit of employment. The bill bans employers from providing benefits “that duplicate payment for any items or services for which payment may be made under the Medicare for All Act of 2017.” The government would have a monopoly with no opt-out except for the rich who can pay the entire cost of their care out of pocket. As a Heritage Foundation study puts it, “competition with the government health plan would be illegal.”
• Berniecare would require federally funded abortion. Currently, an uneasy modus vivendi has been reached on abortion. It is legal in every state by court order, of course. But federal tax money cannot be used to pay for abortion under the Hyde Amendment. Berniecare would destroy that comity, requiring that all medical services be paid from a federal government trust fund and explicitly stating that the fund would be exempt from laws like the Hyde Amendments that restrict “the use of Federal funds for any reproductive health service.”
• Berniecare would eliminate medical conscience rights. In the name of “non-discrimination,” the legislation would coerce doctors, nurses, and other medical professionals into performing services to which they have religious or moral objections. Saying “no” to any legal service requested by a patient would be deemed discrimination—which would obviously guarantee access to abortion, sex change surgery, infertility treatments, and perhaps one day assisted suicide. This provision of the Medicare for All Act, with malice aforethought, would drive pro-life and other Hippocratic oath-believing doctors and nurses out of medicine.
• Berniecare would bust the budget and lead to rationing. According to the Urban Institute, Medicare for All would “increase federal government spending” by $32 trillion—that’s trillion with a T—over its first 10 years. Think about the tax increases required to even approach covering those costs—which, as with Vermont’s stillborn law, are not specified in the legislation. Everything we know about government health care in places like Canada and the U.K. suggests the near certainty that the mammoth price tag would lead to stringent cost controls along with rationing by onerous wait times for tests, surgery, and other treatments.

It would be easy to assume that such a radical bill will never pass Congress. Don’t be so sure. If the Republicans implode in 2018 and a strong Democratic majority emerges, President Trump might well decide it would be “the greatest health care we have ever had.” One of his most noteworthy deviations from mainstream Republican views as a candidate came in his repeated statement that he wants universal heath care coverage. Moreover, the bill already has 16 Democrat co-sponsors, significantly including such potential or likely presidential candidates as senators Elizabeth Warren, Kamala Harris, and Cory A. Booker. More than half the Democratic House caucus has signed onto Rep. John Conyers’s companion legislation in the House of Representatives.

Public opinion polls are also supportive. The Economist recorded public support at 60 percent, a Harvard poll had it at a whopping 66 percent, and the Kaiser Family Foundation poll at 57 percent. Sure, that support would drop as people learned more about Medicare for All. But as we should have learned from Obamacare, a bill doesn’t have to be popular to become law, and a health care system doesn’t have to be functional to endure.