Bernie Sanders Medicare-for-all plan is all wrong for America It would be senseless to replace employer-based coverage with an expensive one-size-fits-all system that couldn't handle treatments of the future.

Marc Siegel | Opinion columnist

Show Caption Hide Caption Sanders unveils 'Medicare For All' bill Sen. Bernie Sanders is proposing legislation that would let Americans get health coverage simply by showing a new government-issued card. And they'd no longer owe out-of-pocket expenses like deductibles. (Sept. 13)

My 93-year-old father recently came home from the hospital proudly harboring a life-saving $50,000 aortic valve paid for by Medicare, though he rode home in a wheelchair that Medicare didn’t pay for. This gap in services is growing, as Medicare struggles to cover emerging technologies that are not one-size-fits all while at the same time continuing to provide basic care. If Medicare is converted to single-payer or Medicare for all, as Sen. Bernie Sanders of Vermont proposes, tens of millions more patients will be added to an already faltering system, and the gap between the promise of care and actual care delivered will widen.

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Single-payer is the ultimate one-size-fits-all health care promise. Consider Canada, our single-payer neighbor to the north. One of my patients was visiting Toronto several years ago when he developed worsening angina requiring a cardiac stent. He was placed on a several-week waiting line before giving up and returning home for the procedure. The waiting-your-turn problem has only gotten worse since then. In 2016, the Fraser Institute found a median 20-week wait in Canada between a generalist’s referral and the time the patient actually received a definitive test or treatment/procedure from a specialist.

Americans already face a wasteful health care system with inadequate access to care. The Commonwealth Fund ranked us last among 11 wealthy nations this summer. But unlike Canada, we will never tolerate such long waiting lines, which is one of the reasons single-payer will never work here.

Despite growing problems in access and cost, most Americans don’t want change to jeopardize what works. A 2016 Gallup Poll revealed that 65% of Americans are happy with the way the healthcare system works for them. The backbone of our system is employer-based health insurance. Some 170 million Americans rely on coverage at their job, and employers receive an incentive to offer it in the form of a tax deduction.

More than 55 million Americans are covered by Medicare at a cost to the taxpayer of around $650 billion a year. More than 70 million are covered by Medicaid, at a cost of $532 billion.

Medicare-for-all would be far more expensive, especially given the rising cost of health care technologies. Last year the Urban Institute estimated that the Sanders plan would cost a whopping $32 trillion between 2017 and 2026, a completely unworkable number.

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And both Medicare and Medicaid are already struggling to find doctors who still want to work with them. About 30% of doctors wouldn’t see new Medicaid patients , close to the same as the share of primary care doctors over the age of 55 who won’t see new Medicare patients. This inherent doctor shortage will only worsen if government-run health insurance is expanded.

Finally, the health insurance lobby, quite powerful in Congress, will never allow single-payer to pass, as it would significantly erode its client base. Major health insurers spend millions of dollars lobbying each year to ensure their survival. They were crucial players in the construction of the highly regulated policies of Obamacare which provide millions more clients paying high premiums. Single-payer represents a big threat, and insurers are far too entrenched in Congress to lose the battle.

Single-payer isn’t the answer to providing health care in an exciting future where cancer and other treatments are genetic-based and personalized. For instance, CAR-T involves removing a patient's immune cells and genetically engineering and reinserting them to fight cancer. Single-payer will never be able to justify payment for a $500,000 technology on a patient-by-patient basis.

Food and Drug Administration commissioner Dr. Scott Gottlieb told me recently that the insurance model isn’t necessarily prepared to cover the latest treatments where “a one-time administration of a drug could potentially cure a disease.” He added, “I worry about access to therapies, particularly effective new therapies so it would be concerning if we had really impressive new treatments and patients couldn’t get access to them because the models weren’t right or patients were uninsured or underinsured for the medicines that they use.”

Bernie Sanders’ bloated Medicare-for-all insurance may be extensive, but it is not designed for the personalized cures of the near future. It is also definitely not the kind of national catastrophic national health insurance that Theodore Roosevelt had in mind during his 1912 “Bull Moose” presidential campaign, or Richard Nixon's comprehensive coverage plan that built on the existing employer-based system (proposed in 1974 but soon eclipsed by Watergate).

It makes a lot of sense for all patients and hospitals to be covered in the event of a sudden health catastrophe so that neither they nor the hospital that saves them goes bankrupt. But it makes little sense for single-payer to threaten an employer-based market that’s already working.

Marc Siegel, a member of USA TODAY's Board of Contributors and a Fox News medical correspondent, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. Follow him on Twitter: @DrMarcSiegel.