Sen. Bernie Sanders introduces the “Medicare for All Act of 2017” on Capitol Hill, September 13, 2017. (Reuters photo: Yuri Gripas)

The bad math and foolish politics of single-payer health care

How rudderless is the Democratic party? Its membership is so bereft of leadership and policy direction that 16 of its senators have signed on to a health-care bill sponsored by a self-avowed independent democratic socialist from Vermont.

The “Medicare for All Act of 2017″ would repeal Obamacare, along with most other private and public insurance, and replace it with a government-run, one-size-fits-all, centrally directed system of reimbursement for medical expenses. Sanders, who honeymooned in the Soviet Union, holds the same opinion of health insurance as he does antiperspirants: “You don’t necessarily need a choice of 23 underarm spray deodorants or of 18 different sneakers when children are hungry in this country.”


Senators Harris, Booker, Gillibrand, and Warren, who in addition to co-sponsoring the bill may soon be fighting each other, as well as Sanders, for the Democratic nomination, are generals reenacting the last war. They saw how well Sanders did against Clinton, they have marched in the anti-Trump “resistance” movement, and they want to inoculate themselves from accusations of ideological heresy.

Which is why they embrace the thin-skinned and irritable senator whose wife is under federal investigation. What the copycats forget is that the future in politics is never a straight-line projection of the present, much less of the bizarre circumstances surrounding the 2016 Democratic primary. “Medicare for All” might strike Warren & Co. today as legislation worthy of support for reasons both moral and self-interested. In time, however, palling around with Bernie Bros may become a liability.

For one thing, the policy is remarkably vague. “Mr. Sanders did not say how he would pay for his bill,” writes Robert Pear of the New York Times. “Aides said he would issue a list of financing options.” The “options” are not included in the bill — but they are enough to raise the hair on the back of one’s neck.


The experiences of Vermont, whose single-payer system collapsed several years ago, and of California and New Jersey, whose true-blue legislatures can’t carry single-payer across the finish line, and of Colorado, which voted overwhelmingly against a similar plan last year, suggest the tax increases necessary to sustain expanded coverage frighten even Democrats. Examining a similar policy introduced by Sanders during the presidential campaign, the liberal Urban Institute concluded the following:

National health expenditures would increase by $6.6 trillion between 2017 and 2026, while federal expenditures would increase by $32 trillion over that period. Sanders’s revenue proposals, intended to finance all health and non-health spending he proposed, would raise $15.3 trillion from 2017 to 2026—thus, the proposal taxes are much too low to fully finance his health plan.



No wonder Sanders wants to avoid the details. He and his co-sponsors are in a bind. There is no way to pay for the benefits they desire without a) economy-crushing tax hikes, b) rationing, or c) some combination thereof. That chases away support.

Nor is that support deep to begin with. Vox, citing research from the Kaiser Family Foundation, explains that “support for single-payer drops about 20 percent when people who initially said they supported the proposal are told it would give the government too much control or require Americans to pay higher taxes.” Universal coverage with no copays sounds nice at first. But both voters and politicians recoil when they are confronted by the reality of exorbitant costs and diminished freedoms.

The inconvenient truth of the health debate is this: The vast majority of Americans are not only insured, they are satisfied with their insurance. They might grumble about premiums or deductibles or choice of doctors, but they are not about to embark on systemic change. Two-thirds of the some 150 million Americans who receive health coverage through their employer told the Gallup organization they were satisfied in 2016. About three-fourths of the plurality of Americans who receive coverage from Medicare, Medicaid, or the VA said the same. Why overthrow those arrangements cavalierly for Sanders’s revolution?

As President Obama would say: This isn’t my opinion. It’s the conclusion of liberals who would embrace a single-payer system if they had to recreate American health care from scratch. “A commitment to universal health coverage — bringing in the people currently falling through Obamacare’s cracks — should definitely be a litmus test,” writes Paul Krugman. “But single-payer, while it has many virtues, isn’t the only way to get there; it would be much harder politically than its advocates acknowledge; and there are more important priorities.”


Recall what happened the last time Democrats tackled health care. The designers of the Affordable Care Act went out of their way to get buy-in from all the various players in the health-care system. They based their plan on Mitt Romney’s legacy in Massachusetts. Yet the controversy over Obamacare’s mandates, taxes, regulations, and panels cost the Democrats the House, and the negative reaction to the law’s implementation in 2013 and 2014 cost them the Senate. What would be the fallout if Democrats, reduced to their weakest position in years, took on not only the entirety of the health-care industry but also the status-quo bias of the American people?

The headlines the Left has generated this week include single-payer health care, draping a tarp over a statue of Thomas Jefferson on the University of Virginia campus, the resignation of the mayor of Seattle after a fifth accusation of child abuse, the Bob Menendez corruption trial, and Hillary Clinton’s latest sanctimony tour. That man in the Oval Office? He can only be smiling.


— Matthew Continetti is the editor-in-chief of the Washington Free Beacon, where this column first appeared. © 2017 All rights reserved