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  1. #1

    Sander's single payer bill offers little to no details on how it will financed

    Via Vox (emphasis on the relevant parts):

    Sen. Bernie Sanders (I-VT) will release a proposal Wednesday afternoon to transition the United States to a single-payer health care system, one where a single government-run plan provides insurance coverage to all Americans.

    The Sanders plan envisions a future in which all Americans have health coverage and pay nothing out of pocket when they visit the doctor. His plan, the Medicare for All Act, describes a benefit package that is more generous than what other single-payer countries, like Canada, currently offer their residents.

    The Sanders plan goes into great detail about the type of coverage Americans would receive. But it provides no information on how it would finance such a generous health care system. Americans’ taxes would have to change to pay for this kind of proposal. But it’s impossible to tell who would pay significantly more for their coverage and who would pay less, and by how much. This is a crucial part of any health care plan, and in the Sanders proposal, it is notably absent.

    So while the plan would certainly move the American uninsured rate from around 8.8 percent to nearly zero in theory, it’s impossible to tell what it would take to get there and what the bigger economic picture would look like if we did.

    The Sanders bill includes an exceptionally generous benefit package
    Sanders’s single-payer proposal would create a universal Medicare program that covers all American residents in one government-run health plan.

    It would bar employers from offering separate plans that compete with this new, government-run option. It would sunset Medicare and Medicaid, transitioning their enrollees into the new universal plan. It would, however, allow two existing health systems to continue to operate as they do now: the Veterans Affairs health system and the Indian Health Services.

    Those who do qualify for the new universal Medicare plan would get four years to transition into the new coverage. In the interim, they would have the option to buy into Medicare or another publicly run option that does not currently exist.

    Eventually, though, they would all end up in the same plan, which includes an especially robust set of benefits. It would cover hospital visits, primary care, medical devices, lab services, maternity care, and prescription drugs as well as vision and dental benefits.

    The plan is significantly more generous than the single-payer plans run by America’s peer countries. The Canadian health care system, for example, does not cover vision or dental care, prescription drugs, rehabilitative services, or home health services. Instead, two-thirds of Canadians take out private insurance policies to cover these benefits. The Netherlands has a similar set of benefits (it also excludes dental and vision care), as does Australia.

    What’s more, the Sanders plan does not subject consumers to any out-of-pocket spending on health aside from prescriptions drugs. This means there would be no charge when you go to the doctor, no copayments when you visit the emergency room. All those services would be covered fully by the universal Medicare plan.

    This too is out of line with international single-payer systems, which often require some payment for seeking most services. Taiwan’s single-payer system charges patients when they visit the doctor or the hospital (although it includes an exemption for low-income patients). In Australia, people pay 15 percent of the cost of their visit with any specialty doctor.

    The Sanders plan is more generous than the plans Americans currently receive at work too. Most employer-sponsored plans last year had a deductible of more than $1,000. It is more generous than the current Medicare program, which covers Americans over 65 and has seniors pay 20 percent of their doctor visit costs even after they meet their deductibles.

    Medicare, employer coverage, and these other countries show that nearly every insurance scheme we’re familiar with covers a smaller set of benefits with more out-of-pocket spending on the part of citizens. Private insurance plans often spring up to fill these gaps (in Canada, for example, vision and dental insurance is often sponsored by employers, much like in the United States).

    The reason they went this way is clear: It’s cheaper to run a health plan with fewer benefits. The plan Sanders proposes has no analogue among the single-payer systems that currently exist. By covering a more comprehensive set of benefits and asking no cost sharing of enrollees, it is likely to cost the government significantly more than programs other countries have adopted.

    Would Sanders’s health plan lower American health spending? It’s hard to tell.
    One of Sanders’s main arguments in favor of his health care bill is that American health spending is out of control and single-payer would rein it in.

    There are certainly policies in the Sanders plan that would reduce American health care spending. For one, moving all Americans on to one health plan would reduce the administrative waste in our health care system in the long run.

    American doctors spend lots of money dealing with insurers because there are thousands of them, each negotiating their own rate with every hospital and doctor. An appendectomy, for example, can cost anywhere from $1,529 to $186,955, depending on how good of a deal an insurer can get from a hospital.

    That doesn’t happen in a single-payer system like the one Sanders proposes. Instead of dealing with dozens of insurers that set hundreds of prices, doctors only need to send bills to the federal government.

    One 2003 article in the New England Journal of Medicine estimates that the United States spends twice as much on administrative costs as Canada. A 2011 study in the journal Health Affairs estimates American doctors spend four times as much dealing with insurance companies compared with Canada.

    A single-payer health plan would have the authority to set one price for each service; an appendectomy, for example, would no longer vary so wildly from one hospital to another. Instead, the Sanders plan envisions using current Medicare rates as the new standard price for medical services in the United States.

    Medicare typically has lower prices than those charged by private insurance plans that cover Americans under 65. This suggests that switching to the Medicare fee schedule would be another policy change that would tug health spending downward.

    But there are forces in the Sanders plan that encourage higher health spending too. Its robust benefit package with no cost sharing would likely lead to more doctor visits and hospital trips. As the classic RAND Health Insurance Experiment found, patients respond to lower cost sharing in health care by seeking more treatment. Some of that treatment is necessary, but other services provided are not.

    And the Sanders bill would actually raise the prices currently paid by Medicaid, which covers about 50 million low-income Americans. Medicaid traditionally pays lower prices than Medicare and private insurance. If these patients were absorbed into the universal Medicare plan, their doctors would be paid more each time they were seen.

    We haven’t seen a Congressional Budget Office score of the Sanders plan yet — and it’s hard to know how these countervailing forces (some pushing health spending up and others forcing it down) would interact with one another to change overall health costs.

    The big question Sanders doesn’t answer: how do you pay for it?
    The Sanders plan goes into great detail on what kind of coverage a universal plan ought to offer. But it does not do any work explaining how to pay for such a generous benefit package.

    A Sanders spokesperson said over email the office would release a set of financing options later Wednesday afternoon.

    “There’s nobody who has all of the answers,” Sanders told my colleague Jeff Stein when asked about the financing of his health plan. “Nobody has all the answers. What I can say is we are going to be listing a number of revenue-raising proposals, which will generate more than enough money to pay for what we want to do.”

    Eventually though, somebody will need to have those answers — and they’re not easy to find.

    Financing the health care system that Sanders envisions is an immense challenge. About half of the countries that attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he is in Taiwan, Cyprus, or Vermont, the process is roughly the same: Meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.

    This is what happened when Sanders’s home state of Vermont attempted to create a single-payer plan in 2014. Much like Sanders, local legislators outlined a clear vision of the type of health plan they’d want to extend to all Vermonters. Their plan was arguably less ambitious; it did require patients to pay money when they went to the doctor.

    But Vermont’s single-payer dream fell apart when the state figured out how much it would need to raise taxes to finance its new system. Vermont abandoned the government-run plan after finding it would need to increase payroll taxes by 11.5 percent and income tax by 9 percent.

    It’s true — in Vermont and in the United States — that these increased taxes don’t necessarily mean overall health spending is rising. It’s entirely possible that health spending will go down as taxes go up, with Americans no longer spending billions on premiums for employer-sponsored coverage.

    Single-payer systems change who pays for health care, often shifting more of the burden onto wealthier individuals to create a more progressive system. The proposed 9 percent income tax in Vermont, for example, would be far more expensive for the $100,000 worker than the $30,000 earner.

    But who pays how much more is a key question this Sanders bill doesn’t answer. Until there is a version that does, we can’t know whether the health system the Vermont senator envisions could actually become reality.

    Interesting article, this reminds me of the time republicans made similar vague promises on healthcare, tho this one is slightly more elaborated.

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    I'd never compare him to Hitler, Hitler was actually well educated, and by all accounts pretty intelligent.
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    Already being covered in man baby thread
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  2. #2
    The Undying Didactic's Avatar
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    Quote Originally Posted by Mittens View Post
    Interesting article, this reminds me of the time republicans made similar vague promises on healthcare, tho this one is slightly more elaborated.

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    This is why I voted against him in the primary.
    Do no harm, but take no shit.

  3. #3
    Legendary! PRE 9-11's Avatar
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    I think the funding has been intentionally left out. We all know that the Republican controlled legislature won't be passing a single payer bill. This is a "PR stunt" - meant to put a spotlight on the topic of single payer.
    Quote Originally Posted by Vyxn View Post
    educate your self

  4. #4
    Quote Originally Posted by PRE 9-11 View Post
    I think the funding has been intentionally left out. We all know that the Republican controlled legislature won't be passing a single payer bill. This is a "PR stunt" - meant to put a spotlight on the topic of single payer.
    if the point is to further highlight who is on the right and wrong side of this issue then that would make sense, I at least hope that's what the intention is.

  5. #5
    Legendary! PRE 9-11's Avatar
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    Quote Originally Posted by Sky High View Post
    if the point is to further highlight who is on the right and wrong side of this issue then that would make sense, I at least hope that's what the intention is.
    Well I mean isn't it obvious how we'd have to pay for this? We would need to raise taxes. On the wealthy and the middle class.

    But if that means I don't pay $4,000 in premiums throughout the year, and if that means my $6,000 deductible can go fuck off, then it sounds like a good trade-off.
    Quote Originally Posted by Vyxn View Post
    educate your self

  6. #6
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    Quote Originally Posted by PRE 9-11 View Post
    I think the funding has been intentionally left out. We all know that the Republican controlled legislature won't be passing a single payer bill. This is a "PR stunt" - meant to put a spotlight on the topic of single payer.
    The risk for Democrats is that a sizable majority of the population is covered by employer health insurance or current Medicare. We all saw what happened with "If you like your plan, you can keep it". This tosses that out the window.

    I'll be interested to see the CBO scoring for a plan which is more generous than current medicare (which itself, despite being run through the government, is not terribly good at controlling cost).

  7. #7
    Titan Kujako's Avatar
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    It is a symbolic bill, no point in really flushing it out when it has zero chance of even getting to the floor.
    It is by caffeine alone I set my mind in motion. It is by the beans of Java that thoughts acquire speed, the hands acquire shakes, the shakes become a warning.

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  8. #8
    The Insane
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    As opposed to the incredibly detailed policy plans of one Donald J. Trump.
    things worked out better than we had planned • now everything's ruined, yeah

  9. #9
    Quote Originally Posted by PRE 9-11 View Post
    Well I mean isn't it obvious how we'd have to pay for this? We would need to raise taxes. On the wealthy and the middle class.

    But if that means I don't pay $4,000 in premiums throughout the year, and if that means my $6,000 deductible can go fuck off, then it sounds like a good trade-off.
    believe me I know getting this funded is pretty straight forward.

  10. #10
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    Quote Originally Posted by Kujako View Post
    It is a symbolic bill, no point in really flushing it out when it has zero chance of even getting to the floor.
    Problem for Democrats is going to be (like ACA repeal for republicans) they will probably get put on record with what they think about this.

  11. #11
    Let me help decipher the story:
    1)Single Payer won't happen under republicans
    2)Bernie is running in 2020

  12. #12
    Epic! downnola's Avatar
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    Quote Originally Posted by PRE 9-11 View Post
    Well I mean isn't it obvious how we'd have to pay for this? We would need to raise taxes. On the wealthy and the middle class.

    But if that means I don't pay $4,000 in premiums throughout the year, and if that means my $6,000 deductible can go fuck off, then it sounds like a good trade-off.
    Raising taxes, creating new tax brackets, and mimicking Colorado's Marijuana tax code on the federal level could fund it easily. As long as the option for private insurance is left on the table, and healthcare service isn't nationalized, conservatives should seriously consider it. Healthy people are required for economic growth.
    “Why are you so afraid of the word ‘Fascism,’ Doremus? Just a word—just a word! And might not be so bad, with all the lazy bums we got panhandling relief nowadays, and living on my income tax and yours—not so worse to have a real Strong Man, like Hitler or Mussolini—like Napoleon or Bismarck in the good old days—and have ‘em really run the country and make it efficient and prosperous again.
    - Sinclair Lewis, It Can't Happen Here

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    Titan Kujako's Avatar
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    Quote Originally Posted by Calamorallo View Post
    Problem for Democrats is going to be (like ACA repeal for republicans) they will probably get put on record with what they think about this.
    Or it will just be ignored by everyone in Congress. No reason for anyone to go on the record about it really, though I do support the idea. It's simply a nonstarter and is done only to get the response you are giving it.
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    Quote Originally Posted by Kujako View Post
    Or it will just be ignored by everyone in Congress. No reason for anyone to go on the record about it really, though I do support the idea. It's simply a nonstarter and is done only to get the response you are giving it.
    I really think Bernie is doing it to force the issue going into the 2020 elections. Any Democrat will have to take a stand on an issue which has a significant chance of causing harm in a general election. "You may hate Trump, but he's not going to raise your taxes and take your health insurance plan away. Do you want your health managed by the same people who run the DMV?" So many potential ads I can think of now.

  15. #15
    There's going to be a lot of lies tossed around to get voters to hate single payer. It's going to require a constant stream of truth to win.

    They need to put extra effort into explaining that while taxes will be higher, the average person or family will have more money each year compared to now.

  16. #16
    Quote Originally Posted by Kujako View Post
    Or it will just be ignored by everyone in Congress. No reason for anyone to go on the record about it really, though I do support the idea. It's simply a nonstarter and is done only to get the response you are giving it.
    the early prospects for 2020 are already fighting to be left of their opponent on this issue. As others pointed out this is a mix of a pr stunt and a line in the sand litmus test for would be presidential candidates

  17. #17
    @Skroe gave a perfectly good example of something that looked workable (Japan's system)

    I honestly wonder why we have zero politicians putting anything out that even remotely resembles it.

  18. #18
    Titan Kujako's Avatar
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    Quote Originally Posted by Resurgo View Post
    I honestly wonder why we have zero politicians putting anything out that even remotely resembles it.
    Found over 58 million reasons.
    It is by caffeine alone I set my mind in motion. It is by the beans of Java that thoughts acquire speed, the hands acquire shakes, the shakes become a warning.

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  19. #19
    Main problem I see with Sander's proposal is the lack of co-pays. Without them, people will be utilizing medical doctors and facilities far more freely for even minor issues which will put a heavier strain on the government.

    Besides that, we know how the system will be funded. Small details are not needed until this becomes more than a proposal.
    The wise wolf who's pride is her wisdom isn't so sharp as drunk.

  20. #20
    Quote Originally Posted by kail View Post
    Main problems I see with Sander's proposal is the lack of co-pays. Without them, people will be utilizing medical doctors and facilities far more freely for even minor issues which will put a heavier strain on the government. Besides that, we know how the system will be funded. Small details are not needed until this becomes more than a proposal.
    That's more of an education/awareness issue than a co-pay issue. Folks need to realize that you don't need to go to the ER for a minor laceration on your finger, going to your doctor or somewhere like an urgent care facility is far more appropriate as it's both the kind of thing they're there for (non-emergencies) and it's far cheaper for all involved. It's something that many ER's began seeing after the ACA was put in full effect and folks who never had health care all of a sudden did.

    For those of us who have had health care the whole time, it's a no-brainer issue and many of us are pretty familiar with the ins/outs of the health care system (especially if you've had family who have been sick/injured frequently). For folks who aren't familiar with it, there's a lot of education needed to help those folks make the best, most effective (in all senses) use of the health care system both for their own personal benefit and for the benefit of the system as a whole.

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