“In California, the debate is not over,” Bernie Sanders tells a visibly skeptical Jake Tapper about single-payer health care on yesterday’s State of the Union. The Senator from Vermont oddly never offers a response to why his home “cobalt-blue” state rejected single payer, where Gov. Peter Shumlin did declare the debate over after getting estimates of the projected costs of socialized medicine and the eye-popping taxes it would require. Sanders, who will introduce a Medicare-for-all bill at some point this session, insists that single-payer systems save money through the efficiency of monopolies (via the Free Beacon):

Sanders pushed back against Tapper, citing “studies that [he] has seen,” and said that single-payer would save the average family “significant sums of money.” “If you look at Canada’s single-payer health care system per capita, their costs are far far less than the United States,” Sanders said. ” If you look at the UK, if you look at countries around the world, all of which have different approaches to a national health care system, in every instance, they are spending substantially less per capita than we pay in the United States.” … “The problem with our system is it is so complicated for the consumer, for the doctors, is that a hospital, for example, might be dealing with 15, 20, 30 different insurance policies,” Sanders said. “It takes an enormous amount of time, energy, and expense to figure out that you have a $5,000 deductible, you have a $10,000 deductible.”

Color me skeptical too, but it hardly seems likely that the worst problem facing the US medical system is determining deductible levels. In fact, that’s not an issue that doctors or hospitals deal with at all. That’s the insurer’s issue, not the provider’s. The provider bills the insurer for whatever the cost of services was (within the negotiated rates for in-network providers), and the insurer then tells the provider what to bill directly to the consumer after calculating the out-of-pocket costs already borne by the consumer that year. Thanks in part to privacy laws, there’s no way that one provider can access the billing information on a consumer to figure out when the deductible gets satisfied, even if they were so inclined to do so, which they’re not. If managing deductibles drives up costs at all, it drives up the administrative costs of insurance, not care, although there are plenty of other administrative costs borne by providers in dealing with insurance.

If someone wants to assert the kind of superior knowledge necessary to reinvent a sixth of the nation’s economy, isn’t the management of deductibles the kind of basic knowledge one would assume they’d already have?

Tapper wonders why Vermont gave up on single payer, even after it passed in the legislature in 2011. Sanders blamed politics rather than economics:

“Why couldn’t this happen in Vermont, then?” Tapper asked. “What’s the issue in Vermont? Vermont would be a perfect test case.” “Politically this is difficult,” Sanders said. “Look, taking on the insurance companies and the drug companies, taking on Wall Street, taking on a lot of very powerful forces that make millions of dollars a year from the current health care system is not going to be easy.”

Er … Vermont had already taken on those entities in 2011 and passed Act 48 anyway. All that was needed was a financing method for the single-payer system, and Shumlin ended up choking on the tax projections necessary to make it work. The problem wasn’t beating Big Insurance — it was hiking taxes by enormous amounts on voters, all for a system that has been repeatedly proven to deliver substandard access and often substandard care. If anyone doubts that, just ask how the federal government’s existing single-payer plans are faring: the Veterans Administration and the Indian Health Service.