The Burdens of BernieCare Congress’s budget gnomes tip-toe around single-payer’s reality.
https://www.wsj.com/articles/the-burdens-of-berniecare-11557091123
Bernie Sanders sells Medicare for All as a simple idea: “You will have a card which has Medicare on it, you’ll go to any doctor that you want, you’ll go to any hospital that you want.” So the Congressional Budget Office provided a public service last week by describing, albeit in thick and cautious bureaucratese, what it would really take to float BernieCare.
Democrats asked CBO to lay out some parameters of how to set up single-payer, hoping to elude analysis of any one bill in Congress. The latter would carry political accountability—and a price tag. Instead CBO walks through “key design components and considerations” in a report that aims to bore and deploys the word “could” 209 times.
Yet even this limited analysis is instructive about the “major undertaking” of single payer, as CBO puts it in hilarious understatement. CBO acknowledges, for example, that a transition that includes moving 160 million people from employer-sponsored coverage to single payer would be “complicated, challenging, and potentially disruptive” to health care and the economy. You don’t say.
The Sanders Medicare for All bill would ban private coverage that competes with government. CBO notes dryly that single-payer proposals often prohibit private insurance because “some high-income people might prefer to purchase substitutive insurance that offered more generous benefits or greater access to providers.” Can’t have people using their own money to buy better health care.
And you can’t go to any doctor you want if government isn’t paying providers what services really cost. The point of Medicare for All is to cut reimbursement rates to Medicare levels, which government can now set so low only because private commercial reimbursement rates are so much higher. Cutting reimbursement rates would “probably reduce the amount of care supplied and could also reduce the quality of care,” CBO says.
Who would decide what government pays for an innovative new treatment for, say, lung cancer and who receives it? CBO walks through some ideas and adds: “Under any of the pricing approaches discussed below, a single-payer system could decide to exclude certain drugs or place those drugs on a nonpreferred drug list because they are too expensive or because they do not have any additional benefit.”
And “unlike a system with competing private insurers, the public plan might not be as quick to meet patients’ needs, such as covering new treatments.” You mean government is less responsive than private business?
There is also an amusing aside on the “standardized information technology infrastructure” the government would likely need, brought to you by the folks who struggled to set up the ObamaCare website. Also: What happens to the Children’s Health Insurance Program, or Tricare, the Pentagon health insurance program?
CBO dares not wade into the details of what all this would cost, though it says “government spending on health care would increase substantially.” Thanks for that. Honest private estimates suggest it would take at least a doubling of individual and corporate taxes. Proponents say the country will save money through lower administrative costs, which CBO says may materialize. But the real savings would have to come from where the money is: cutting payments to doctors and restricting care.
None of this will surprise anyone who has studied health-care markets, but many Americans are hearing about single-payer for the first time. Voters should know Mr. Sanders is promising miracles when what he’ll deliver is poorer care for everyone.
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