The Questions Medicare for All Supporters Must Answer

Vermont senator and Democratic presidential candidate Bernie Sanders has officially unveiled the latest version of his plan for a government-run health-care system. This year, his Medicare for All legislation is co-sponsored by at least five of his fellow presidential contenders: Senators Corey Booker, Kamala Harris, Kirsten Gillibrand, and Elizabeth Warren, and Representative Eric Swalwell. Several other prominent Democrats have voiced their support for the concept, if not Sanders’s specific version of it. And the polls show that voters might be receptive.

What’s more, there is a genuine need for health-care reform. Obamacare remains deeply troubled, with costs rising, choices restricted, and its promise of universal coverage unrealized. Meanwhile, Republicans are divided, dispirited, and largely clueless — opposed to Obamacare, but unable to formulate a plan of their own.

Medicare for All, to a large extent, has filled the vacuum created by that inability. But before we take it too seriously, there are a few questions that supporters must answer:

How will you pay for it? We don’t yet know exactly how much Sanders’s plan will cost, but the price is bound to be high: Previous versions of the plan were estimated to cost $32–38 trillion over the next ten years, and the senator’s latest version would provide even more generous benefits. In fact, both the legislation and the Sanders campaign’s summary of it are extremely detailed about all the benefits the plan would provide. It would cover virtually all hospital and physician care, preventive services, mental-health services, dental and vision care, prescription drugs, and medical devices. And, except for brand-name drugs, there would be absolutely no deductible, co-payment, or other out-of-pocket expenses. The plan would not only provide far more extensive benefits than private insurance plans or today’s Medicare; it would provide benefits in excess of those offered by other national-health-care plans around the world.

But when it comes to paying for all these goodies, Sanders is exceedingly vague. Neither the legislation nor his summary includes a funding mechanism. Instead, Sanders calls for “a vigorous debate as to the best way to finance our Medicare for All legislation.” As far as I know, vigorous debates don’t pay the government’s bills.
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