By Meg Hansen
“Medicare for All,” the single-payer legislation introduced by Vermont Sen. Bernie Sanders, has become the rallying cry for hard-left Democrats eager to submerge Republican-controlled Congress in a “blue wave” this November. This proposed systemic overhaul of American health care would require Congress to impose historic tax hikes (more than doubling individual and corporate income taxes).
Chris Pope (Manhattan Institute) reports that Sanders’ plan would particularly hurt his home state. Medicare for All (M4A) would redistribute federal funds away from states that spend more on health care, like Vermont, in favor of those that spend comparatively less. Bringing Vermont’s health care expenditure to the national average would cause a 31 percent decrease in federal funding, which would prompt Montpelier to raise taxes to pay for the state’s health expenses. At present, Vermonters endure the fourth highest tax burden.
Sanders argues that taxpayers in Vermont, and across the nation, should not balk at M4A’s enormous price tag, i.e. $32.6 trillion for the first decade (according to a Mercatus Center report). Nationalizing health care, he promises, would save the United States $2 trillion over 10 years (a claim denied by the Mercatus report author).
According to advocates, M4A would reduce health care costs by regulating the prices of services and drugs without compromising access to and the high quality of American health care. This coveted, two-fold outcome is a myth. Not only does M4A promise undeliverable benefits but it also will cost Americans more than any numerical figure.
In a single-payer system, the state forces physicians and hospitals to operate within predetermined global budgets. Because various health services have fixed costs, and pioneering medical research is expensive, requiring doctors to provide high quality health care within financial limits necessarily leads to (1) rationing of health care and (2) stifling of medical research and innovation.
Sanders has made a career out of decrying health care in America as inferior to that provided in Europe and Canada. In truth, rationing or the allocation of health services based on cost-effectiveness occurs widely in these nations. Bureaucrats in Sweden and Denmark use discriminatory parameters (e.g. age and quality of life) to decide which persons deserve access to expensive procedures such as chemotherapy and surgery. Similarly, the UK’s National Health Service frequently denies access to innovative treatments that it deems too expensive in relation to the therapeutic benefits.
Another form of rationing entails deliberate decreases in the supply of physician and hospital services, causing prolonged wait times. In 2016, the average Canadian wait time to see a medical specialist reached an all-time high of 20 weeks (compared to 9.3 weeks in 1993). The French health system, which has operated at a loss since 1989 and faces chronic physician and nurse shortages, struggles to manage public health crises like the 2015 flu epidemic. As a result, relatively lesser-trained paramedical technicians assume a greater role as primary healthcare providers.
In critiquing U.S. health care costs, Sanders also fails to consider that our nation carries the global burden of medical innovation. We consistently invest unmatched financial resources in all areas of medical research including imaging, drugs, medical devices and biotechnology.
A report by the USC-Brookings Schaeffer Initiative for Health Policy shows that the U.S. constitutes 27 percent of the global income but accounts for 64 to 78 percent of pharmaceutical revenues worldwide. We spend approximately three times as much as Europeans on drugs because we make greater use of newer and more expensive drugs. Importantly, U.S. drug innovation enables other countries to sell groundbreaking treatments at artificially lowered prices (around four times cheaper).
U.S. taxpayer-funded health care focuses on population niches that are most in need such as the poor, disabled, and the elderly through Medicaid and Medicare. Pope explains that concentrating our tax monies in this manner enables more Americans to avail of unparalleled medical expertise and technologies. Establishing single-payer would disrupt the availability of specialized medicine to the average American.
In a Forbes article series, Chris Conover calculates that M4A would incur (a) $152 billion-$914 billion related to rationing of health services (i.e. increased care for patients waiting for treatment, patient time costs), and (b) between $50 billion and $152 billion a year as a consequence of reduced innovation. But if you want to know the real cost of Sanders’ single-payer project, then don’t ask an analyst or activist.
Ask the 67-year-old man with ALS who wants to live to see his first grandchild or the 12-year-old girl whose father has been diagnosed with malignant pancreatic cancer. The value of America’s trailblazing advancement of medicine, and our unique access to cutting-edge treatments, is priceless.
Meg Hansen, of Manchester, is executive director of Vermonters for Health Care Freedom, a nonprofit committed to free-market reforms in American health care.