How Bernie Sanders would fund his Medicare for All plan

[turbinetree]

On Wednesday afternoon on the second floor of the Hart Senate Office Building, Sen. Bernie Sanders (I-VT) officially unveiled his much-hyped Medicare for All plan. The senator was flanked by his 16 co-sponsors, many of them rising stars in the Democratic party and nearly every one of them talked about as a potential presidential candidate in 2020.

The basic idea of the plan is this: Over the course of four years, the state would expand eligibility for Medicare until every resident of the United States is ultimately covered by the single-payer, taxpayer-funded program.

“Today, all of us stand before you and proudly proclaim our belief that health care in America must be a right, not a privilege,” Sanders said. “Today, we begin the long and difficult struggle to end the international disgrace of the United States, our great nation, being the only major country on earth not to guarantee health care to all of our people.”

The idea is one Sanders has been advocating for decades and one he ran on in the Democratic primary during the last election cycle.

Until recently, the plan was a fringe idea in the Senate, but Hillary Clinton’s loss and the attempts by Republicans in Congress to repeal and replace the Affordable Care Act seem to have changed the calculus.

https://thinkprogress.org/sanders-single-payer-announcement-c880718a31dc/

[BigmanPigman]

1. Two ideas to get the finances for it...

1. Stop allowing Big Pharm amd Health Insur Co. from lobbying the government and ripping America off.
2. Sell tickets and media rights to watch the fake prez and his buddies get a public flogging on their way to the pokey after all of their assets are seized and applied to Medicare for All.

[turbinetree]

6. I could sit down and do the following for the public event for Traitors............

[safeinOhio]

2. If you don't like Medicare for all,

just ask us old farts if we like our Medicare. I find it much better than my old private insurance. All most all doctors accept it, you know what's covered and it goes with you where ever you go. Insurance companies spend a lot of $ on lies against it. Don't believe them, ask those of us on it if we like it.

[turbinetree]

3. I love my Medicare....................it cost me $125.00 a month

My wife pays $425.00 a month to a "for profit" just like the name says "for profit" folks its a no brainier......................

Love Medicare....................

[SFnomad]

34. It costs you $125/month now, but you've paid into it your entire life (I know I have)

So, the actual cost would be well more than that.

[rickford66]

36. No. He subsidized other people's Medicare.

Now, somebody younger is subsidizing his. When you buy a product or service, you're subsidizing the medical care of the employees who produced it.

[SFnomad]

38. I realize that's how it's funded ... but to say that it costs you $125/mo is disingenuous ...

Its total cost to you is what you're paying for it now and what you paid to subsidize everyone else before you became eligible.

[pnwmom]

56. Exactly. And those taxes are only enough to pay for Medicare recipients over 65. They'd have to rise

a great deal to pay for Medicare for all.

[Voltaire2]

5. The Plan makes medicare even better than it is now.

No more alphabet soup plan nonsense. No more copays (well one, 250 max for drugs) no deductibles. No bullshit.

[turbinetree]

8. I pay for heart medication every quarter that costs me out of pocket after Medicare deductibles

a grand total of $225. 00 a year.............if that..................one month I pay $2.25 for medication, my most expensive mediation in my Medicare Part D plan is Omega 3 and it costs me around $50.00 a quarter

I am saving so much money.....................

[TexasBushwhacker]

7. And with Medicare for all, chronic diseases like diabetes

can be managed better. That means people will be healthier when they go into retirement. People will be less likely to become disabled or die prematurely, and those people will continue to work and PAY TAXES. People forget that there is a real cost to people not getting the medical care they need.

[beam me up scottie]

11. That's another really good point.

[stopbush]

17. 19% of Americans are on Medicare/caid. 100% of working Americans pay into the system.

The challenge has been and remains simple: how do you fund a program that includes 100% of Americans when the current program only includes 19% of Americans, even though everyone working is paying to support the program?

Obviously, you need at least a 4-fold increase in tax revenues to handle adding a 400% increase in people covered by the program. How do you do that?

[safeinOhio]

18. The countries that have single payer

spend half what we do as a portion of GPD. Looks like it is way cheaper in the long run.

[stopbush]

19. What countries are those? I'd like to look up the data.

Thanks.

[safeinOhio]

21. Here is a list of the portion of GDP for

every country in the world.

https://data.worldbank.org/indicator/SH.XPD.TOTL.ZS

[stopbush]

28. A useless list, as it doesn't say which if any of those countries use single payer.

All it shows is the % of GDP spent on healthcare. A country with a low% could have really shitty healthcare.

Please try to answer the question. Thanks.

[safeinOhio]

31. Just pick out modern countries

like Japan, Germany, and most Western European ones.

[DFW]

42. It remains a mystery to me why people always say they KNOW Germany has single payer. It doesn't.

This was some kind of myth attached to the Sanders campaign last year, certainly not put forth by Sanders, who presumably would have been smart enough not to say something so ridiculous and easily disprovable.

I live in Germany and am married to a German social worker. Germany has a complicated patchwork system of health care insurance that is expensive, very complicated, and anything but universal. My wife had to contend with many of the several hundred thousand Germans who have no health insurance at all. As for myself, I tried to get German health insurance when I moved there, but the best quote I could get, due to a pre-existing condition, was €2500 a month, or $35,000 a year. Good deal, right?

When my wife took early retirement at age 60 due to a combination of medical issues and mobbing by her employer, I got the privilege of picking up her monthly €700 (I had thought it was €400--she corrected me. I paid money into her account for her personal expenses, so I didn't see the bills) health insurance bill. Now that she turned 65, she is supposed to get the German version of medicare, although it has been 3 months and she hasn't gotten the paperwork yet.

Most Germans are covered by one of a group of agencies/companies that exist for various classes of people, depending on their jobs, employers, status as employed, unemployed, disabled, etc etc. If your earn "too much," you are required to get "private" insurance, which is expensive, but gets you First Class care when you need to see a doctor. "Private" patients go to the front of the line when there is one, and get the single rooms at hospitals. They pay up front, and submit the bills to their insurance companies to hopefully get reimbursed. Many procedures are not covered by private or "working class" insurance, and patients are out of pocket.

[safeinOhio]

33. This will help

http://www.pbs.org/newshour/rundown/health-costs-how-the-us-compares-with-other-countries/


Just remember we are the only modern country that does not have universal medical coverage for everyone, and we spend the most.

[DFW]

46. I guess Germany is not modern

We do not have universal medical coverage for everyone.

[ProfessorPlum]

49. it's basically every country

we pay twice as much just in the government portion for our healthcare, and get shitty results.

[Demsrule86]

44. The poor won't be able to afford Medicare which has a 20 % deductible and no cap ...think on that

for a while.

[safeinOhio]

53. That's why they have

Medicaid.

[stopbush]

54. That's why there's Medicaid, no?

[haele]

27. IME, There are only three types of Seniors I've known that don't like Medicare....

1) Ones who had free nearly free healthcare for decades while they were working (so-called "Cadillac plans&quot , and can't understand why they can't just continue that great health insurance plan once they stop working for that large corporation or as part of their union benefits.

"What do you mean I have to pay for this? I thought this was Socialist Medicine. Didn't I already pay for it with my taxes all these years?"

2) ones who never needed to have health insurance (on either cheap plans or went without) until they got old and they were surprised by the cost and service provisions involved in dealing with geriatric health care.

"I never got sick before, I'll just die in my bed around 70 like my Grandfather and his father before him before I pay these premiums..."

3) Well-to-do Randriods who can pay cash all the time and think both taxes and Medicare is set up to be an insult and a rip-off to them - primarily because it doesn't treat them like the special people they are with the Concierge service they think they should be accustomed to.

"What is this cheap broken bureaucratic crap you're pushing on me? The Government made me pay my hard earned taxes for this "service" , and I have to share my health care with all those useless moochers??"

Even my wealthy FIL and his wife (who works as an executive on a hospital charity board) thought/think Medicare is great...


Haele

[greatauntoftriplets]

51. I'm pissed off at Medicare and don't fall into either of the three catergories you list.

Medicare has denied a treatment the doctor wants me to have for an extremely rare autoimmune disease because it's not on "the list". The maufacturer's assistance program will pay for it only if my private supplemental insurance will pick up the cost. That's a joke, since that insurance pays based on what Medicare allows.

Because this particular treatment is $2,500 per infusion, there's no way in hell that I can pay for it.

My point is that it's impossible to generalize who likes Medicare because everyone has their own experience that doesn't fall into neat categories.

[haele]

52. I commiserate with you in your situation - it's not just Medicare that pulls these denials.

My spouse is in the same as you, even with our current employer based insurance (one of BCBS PPOs).

He's got a fairly rare auto-immune syndrome that requires among other medicines he takes a monthly shot of Humira to keep it under control so he can still function - which costs anywhere from $2800 to $3000 a month, and insurance doesn't want to do more than provide what's basically a 20% off coupon.
There's another where we're now paying $125 a month using a RX coupon for one of his necessary psychotropic medicines (Geodon) that for some reason isn't covered under our current policy BCBS formulary - and the generic (Ziprasidone) we can get apparently get through our insurance costs $40 a pill, because BCBS wants us to pay $850 for his prescribed 90 a month at "20% of their cost".

What really pisses me off is that seven years ago, when he started this medication, our previous insurance (Aetna) only charged us $10 a month for the generic (same prescription) and according to one of the prescription information receipts we receive with every prescription pickup if we had wanted to purchase the name brand out of pocket, it would have only been $360. And they covered the Humira he had been using since 2006 at $50 a month.

Pharmaceuticals are a rip-off. And all the insurance companies go along with the scam to pocket more money.

We expect the "we don't want to pay even 80% for this" from all of the insurance companies for some of his medications to continue when we're eligible for Medicare, just based off our observation on what his doctor is doing.

So we had to get his doctor to sign him up with the manufacturer for a 2-year discount where we pay out of pocket $20 a month for the shot - and the manufacturer only has a certain amount of "slots" a year where they are willing to give that discount out.

As I said, the categories I mention are "in my experience". I'm sorry that you are in this situation.

Haele

[trof]

32. This old fart agrees.

[beam me up scottie]

4. Bravo, senators!

"Today, all of us stand before you and proudly proclaim our belief that health care in America must be a right, not a privilege,” Sanders said. “Today, we begin the long and difficult struggle to end the international disgrace of the United States, our great nation, being the only major country on earth not to guarantee health care to all of our people.”

[frazzled]

9. But the bill doesn't contain any financing proposals

They're just a separate set of options that have been put forward "for discussion." Passing a bill about what Medicare for All would cover and how it would work is the easy part. One could envision it passing, given a sufficient Democratic majority. But, of course, you can't implement the program without the financing, and I can't see it being easy at all to pass that, even given the various options proposed (most of them are non-starters). So the current bill itself is just a position paper, really. A wish list. Paying for it is what counts, and what is the really hard part. I don't understand how a bill exists that doesn't include the specifics on how it would be paid for. Wouldn't it be subject to the Pay-as-you-go law (passed by Democrats, btw)? How do you separate the program from its implementation, legislatively?

The Sanders plan goes into great detail on what kind of coverage a universal plan ought to offer. But it does not do any work explaining how to pay for such a generous benefit package.

A Sanders spokesperson said over email the office would release a set of financing options later Wednesday afternoon.

“There’s nobody who has all of the answers,” Sanders told my colleague Jeff Stein when asked about the financing of his health plan. “Nobody has all the answers. What I can say is we are going to be listing a number of revenue-raising proposals, which will generate more than enough money to pay for what we want to do.” . . .

Financing the health care system that Sanders envisions is an immense challenge. About half of the countries that attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he is in Taiwan, Cyprus, or Vermont, the process is roughly the same: Meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.

https://www.vox.com/policy-and-politics/2017/9/13/16296656/bernie-sanders-single-payer

[PSPS]

10. Everyone's taxes would go up but be more than offset by elimination of for-profit premiums.

[frazzled]

13. Read the actual,list of proposals

Which have 8 or 9 different things to discuss down the pike as possible revenue sources. Even then, these proposals are not attached to the bill. At least at this point. My questions remain.

[Eliot Rosewater]

26. It could be paid for, problem is it would require

many new conditions that include how we educate our doctors, taxing corps and rich people more appropriately, and so on.

It can be done, it MUST be done.

But we must first

a. elect democrats

b. outline the hard truth about how we will pay for it, which we can do if we can tell the truth of how

[Demsrule86]

45. People who have work insurance are subsidized by their employers and what in the world

makes you think they will be thrilled...in 94 people sure were not thrilled by Hillarycare...this is why insurance is so difficult. You have a minority of people who don't have it...most still get it at work...so writing a plan for all when most get it at work and won't want it is foolish and it won't pass...a public option which allows people to be added on as workplace insurance dwindles makes way more sense...single payer (there are few examples of single payer in Europe or elsewhere, but universal health is the goal) is a 20th century solution to a 21st century problem...I feel instead of looking for solutions that will work for our time...they go back to the old way...like fighting the last war.

[tonyt53]

12. It is "free", just like the college tuition. Oh, those "how to pay for it" thingys do get in the way

People easily forget that Hillary tried to get America moving in this direction about 25 years ago. Where did that go? It is easy to just toss it out, get a bunch of people on a bandwagon supporting it, but do not have a clue how to pay for it. I keep hearing about how people's money will go to this "free" plan instead of to private insurance companies. Where is the cutoff period? Who starts paying in to this free plan and when do they go on it and leave their private insurance plan? All some people are hearing is "free" and they are willing to make a god out of the person who said "free" today. How many people think there is a chance in hell this proposal, or anything close to it, even hits the floor for a vote in the House or Senate? Not a chance it will happen until Democrats take back both the house ans Senate AND presidency. Not a chance of that happening for quite some time. Questions are "free" too.

[Demsrule86]

14. We will lose it all...the ACA and a shot at universal coverage...which is not neccesariy Medicare

for all...Americans will pitch a fit when they hear the cost...and insurance companies will fight tooth and nail...and there will be job losses...it simply will not work...and you won't even get a shot until you have a super majority which is years away.

[TexasBushwhacker]

22. Frankly, the insurance companies had their chance

Sure, they negotiate prices down from the hospitals' "list" price, but there is nothing in place to control what hospitals and pharmaceutical companies charge. When you're in the hospital, the list price for a Tylenol may be $50 and the insurance companies negotiate it down by half. But $25 is still too much to charge for a damn Tylenol!

So insurance companies could have held hospitals' and pharmaceutucal companies' feet to the fire and refused to pay the exorbinant prices, but they just took the easy way out and passed all the cost increases by raising premiums.

[Demsrule86]

24. And they will have it again...because this bill is going nowhere...and the ACA may just fail

because we waste or time with a hopeless bill. single payer will not pas now.

[Eliot Rosewater]

29. I wish you wouldnt use that phrase, the rightwingers use that line

about it being free and there is no free lunch, etc.

Per my post above, it will require MAJOR changes to everything including taxation, medical schools, curbing profits from RX, eliminating for profit hospitals other than for rich people who want private rooms, etc.

Nobody is saying free, we can criticize what is being done and should, that it is a waste of time to do it now given that we dont have the power to do it and ACA is at risk while we do it, but I would love to never hear that phrase again about being free.

[Hoyt]

15. It's worth it in my mind, but I think the middle class is going to balk when they see the increased

taxes required to cover the uninsured, pick up dental, eliminate co-insurance and deductibles, etc. We can talk offsets to premiums and other costs we are paying out of our pocket now, but people aren't going to believe it.

In the past few years, legislators or voters in Vermont, California and Colorado either said "No, I ain't telling taxpayers that," or said it's going to be too difficult to explain to folks.

I think we are going to get there faster with a Public Option. If it is as good as people think, folks will gravitate to it quickly. No one will feel like it's being stuffed down their throat. There are a lot of people who will never be convinced single payer is best. At least with a Public Option, they can compare the government plan to other plans available and make a choice. A Public Option (essentially Medicare buy in) is an easier sell to ignorant cowboys than "here it is, you have to take it." Christ, I can see the white wing militias shooting people from bridges.

[TexasBushwhacker]

23. I'm fine with a public option

I think it would be a good way to ease into single payer, especially if they had a way that small companies could buy into it for their employees.

[tonyt53]

55. BINGO!!!!! Maybe starting at the age of 50 for starters

[mainer]

16. Right now I'm paying $12,000 a year in insurance premiums

I would happily pay that in taxes if I got medicare instead.

[safeinOhio]

20. Plus one for your post

[Demsrule86]

25. You are one person based on your premiums near retirement age.

[mainer]

41. Lotta folks in their early 60s paying sky high premiums

You bet we'd be happy to get Medicare with that money. Or don't our opinions count?

[Demsrule86]

50. And you wouldn't even get insurance of any sort if you didn't have the ACA.

I knew tons of folks in their 50's and 60's who could not buy insurance at any price before Obamacare. My parents paid $2000.00 a month in the late 80's and early 90's in Connecticut for insurance and the only reason they had it was the insurance pool that Connecticut has...they used up everything my Dad worked for his entire life...I think Medicare for 55 and older would help...and that is doable not right away but doable. There will be no single payer anytime soon so let's work to save what we have...the ACA. If we lose the ACA, it will be years before we can get any sort of insurance.

[underpants]

30. The 6.2% employer tax and NOT having to provide health insurance is a selling point

and I mean for businesses.

I heard that this more and thought GENUIS!!

[Ruby the Liberal]

35. That was my reaction

My employer pays ~$600/month for each employee in premiums. Pool that with the 12.4% paid in now, and it may be a real win.

[roamer65]

37. Similar to OHIP in Ontario.

There is an employer tax of similar percentage. Vision and dental are still employer provided in Ontario.

I would also support a NST if needed.

[GulfCoast66]

48. Do not disagree but...

The people in this country who have the best health care are those with good employer provided plans. And that is still a high percentage of working people. They are not going to be willing to trade their bird in hand for 2 in some promised bush. That will doom this plan from the get-go.

[Ghost Dog]

39. Perhaps, just perhaps, some of the tax revenues currently feeding the gaping maw

of the Military-Industrial Complex could be diverted to this possibly more worthy cause?

[roamer65]

40. ..

[Demsrule86]

43. There is not one word about funding in this article...

No words on what taxes would be raised... I am assuming payroll taxes which are very regressive as they stop at $100,000. And what makes folks think that those who have work insurance want to change or pay higher taxes? It will not happen. We are no closer than we ever were...and we may lose the ACA because of this. That should be our priority not something that can't pass until at least 2020 and probably won't then because we need a super majority and that could be years away. We tried for insurance for 100 years...Pres. Obama got a plan which people support and now we turn to this...it is foolish, and if we lose insurance of any sort which is likely, thousands will die. I consider it irresponsible. Once the ACA is secured, campaign on single payer...I think it won't work with most still getting workplace insurance as was the case with Hillarycare...but hey have at...but not before you have done the right thing for the American people by making sure the ACA survives.

[Demsrule86]

47. I read the article and the title does not match ...no mention of funding.