Today’s Managing Health Care Costs Number is $1.38 trillion
Bernie Sanders released (some) details of his universal health care program today – before the beginning of the South Carolina Democratic debate.
In the debate itself, Clinton argued that the Democrats had fought long and hard to attain Obamacare, and she said the Democrats should fight to improve it, and not take on the innumerable interests that would strenuously opposed a more disruptive change in American health care. Sanders argued that we have 29 million who remain uninsured (the NY Times fact checkers agree) – and that we therefore need a revolution in health care. He’s fond of revolutions. Martin O’Malley got little air time – though he did get to trumpet the stated success of all payer rate setting in Maryland.
I’ve reviewed the short Sanders white paper.
The Gist:
· Health care now costs $3 trillion a year, and he states that his approach would save $6 trillion over a decade (20%)
· BernieCare would have no deductibles and no cost share. That’s highly likely to increase utilization, although the Sanders plan does not account for increased utilization
· He states that the total cost of expanding to universal health insurance will be $1.38 trillion – and he lists how he will achieve this revenue. Note that elimination of tax deductibility of employer-sponsored health insurance represents a quarter of the new ‘revenue’.
Here is the breakdown of how Sanders would pay for this $1.38 trillion bill:
Source
There are still a lot of dollars unaccounted for. The combination of out of pocket payments and commercial insurance costs alone represent $1.5 trillion –and that’s not counting charitable spending, some local programs, public health costs and employer sponsored direct provision of care. CMS actuary is the source; I used 2016 projections. SandersCare comes up short even after savings from lowering administrative costs, and even excluding increased utilization with abolition of out of pocket costs.
Some of my liberal friends are enthusiastic that the Bernie Sanders ‘surge’ has brought the idea of a single payer health system back into the conversation. But having seen the state of Vermont abandon its single payer efforts when confronted with the proposed tax bill – I don’t find myself enthusiastic at all. I fear that this conversation takes energy away from all the changes we need to promote in the health care system we now have.
We saw what hell there was to pay when a small number of people saw their health care change as a result of the ACA. The Sanders plan would change virtually everyone’s health insurance – and I just don’t see this happening any time in the foreseeable future.
We saw what hell there was to pay when a small number of people saw their health care change as a result of the ACA. The Sanders plan would change virtually everyone’s health insurance – and I just don’t see this happening any time in the foreseeable future.
