This Is the Strongest Argument Against Medicare for All

A deep-blue state’s failure to enact a single-payer system shows why a national version is unlikely to succeed.

Comments: 185

  1. Medicare for all would be great and achievable. You would get a better health care system for half the price. CEOs and big owners in the medical, healthcare and insurance business would maybe lose some millions, not that they would notice. If each and every developed (and many developing) countries can, you can. Don't tell me you cannot afford it, you pay twice as much as anyone else and still rank 48th.

  2. @Chinaski Yes, we pay twice as much (or more) and we get less care and have worse health outcomes too. Our life expectancy is dropping. Half a million people go bankrupt every year from medical costs and over 45,000 people a year DIE because they don't have adequate health insurance (the 45k estimate is also from 2009, I'm sure it's a bit more than that now). Not to mention this system itself is also a public health threat, if you really think about it. Just imagine----the people who can't afford healthcare are the working poor---the ones who handle your food. Not only can they not afford healthcare, they also can't afford to take a day off from work if they are sick because there is no mandated paid sick time in the US either. Does that not sound like a great set-up for an outbreak of communicable disease? Oh no, there's nothing wrong over here at all. This is all fine and anything else just wouldn't work, though.

  3. @Chinaski Trust me, the rich would notice any attempt to shorten them a few millions. They will fight it tooth and nail, even if they have to spent said millions in negative advertising campaigns. Weird isn't it?

  4. These were all state based plans. Any business over 50 employees can be taxed 2-3% to cover healthcare for all Americans. Every working person can pay 2-3% in payroll taxes to cover healthcare for all Americans. Every stock transaction can be taxed $5.00 in order to contribute in a progressive manner. Lastly the defense budget can be cut 2 to 3% to cover the balance. Doesn't this add up?

  5. @Bridget Some economist can check these numbers but I think we are talking about needing 1 trillion dollars per year to cover all Americans.

  6. @Bridget 5% of US GDP is roughly 1 trillion. Healthcare as percent of GDP: USA: 17% every EU country: 10-12% We don't NEED 1 trillion for single payer, we will SAVE 1 trillion.

  7. @Bridget You forget one thing: Think of the cost of insurance every person who is insured pays now. Those numbers are staggering. With Universal Health care, nobody pays premiums so the taxes that are required to offset the cost would be far lower than what people now pay for medical insurance.

  8. Medicare already works and works well. It's called economies of scale. There wasn't enough people in VT for a Medicare for All to work or there may be factors that we are not aware of that caused it to fail. The People want Medicare for All. The only ones against it are those who profit from Americans getting sick and injured and then denying care.

  9. Medicare “works” because it is partially compensated by private insurance payments collected by medical providers. Any Medicare For All discussion must include effect of it on doctors income. It is an elephant in the room that CAN’T be ignored. BTW, I am not a doctor, but a Medicare user.

  10. @Peter Senator Sanders' Medicare for All takes traditional Medicare and makes it better. We as Americans can demand that our government make it work for all people including paying doctors what they deserve. Remember that there would be no CEOs and stockholders to rake in billions for themselves. And, nobody 'likes' their private insurance. Nobody likes copays and out of pocket expenses or not being able to see the provider of their choice or being denied care.

  11. @Peter - Here are some figures from 2011. They would be higher today. rates-really-threaten-physicians-with-bankruptcy/ The author, a private practice orthopedic surgeon, looks at orthopedists and family doctors. He finds that an orthopedist who had only Medicare patients would have a take home income of $411,000. I could live on that. A family doctor who had only Medicare patients would end up with $137,000, a lot less, but you know I could live on that, too (which is more than I ever earned) if I didn't serve Chateau Petrus on weekdays.

  12. That was 2011. 2019 is a different world. Analogy is flawed. State level would have issues not present at the national level. The time is now for Medicare for all.

  13. @Cynthia Even the national program will have to deal with sabotage by people like the author of this piece and others who have a vested interest in the inefficiencies of the current system.

  14. It's strange how a system that is "unworkable" seems to work quite well throughout the world -- providing universal coverage to people at lower prices, coverage that is guaranteed no matter what age one is or what job one has. It is no secret that the insurance companies, pharmaceutical giants, for-profit hospitals and health care facilities, and the American Medical Association do not want changes to the structure of a system that provides them with enormous profits. But, please, let's not pretend this is because the idea itself is bad or unworkable. People, if we want a better system that works for us, we need to demand it. Suderman and other "realists" do not represent our interests.

  15. @Seth Rogoff The problem is that both you and Mr. Suderman are correct. As you say, once you have a single payer system, the government can dictate that doctors and nurses get paid less, hospitals make do with less, thousands currently running our system get laid off, and drug companies receive less profits for R&D. Those are the ways that other countries hold health care costs down. But Suderman is correct in that taxes will go up as employer and employee private health care costs go down, but taxpayers will see the taxes rise before they'll see the costs fall. Everyone will lose their old plan when they get the new government plan. Doctors and hospitals will not just sit and take their punishment; they will re-organize to try to preserve some of their revenues; many will find they have to change doctors; all will find doctors and hospitals treating them differently as costs are squeezed. Transitioning to Medicare for all will be a painful process that lasts a decade or more. Politicians who vote for that change will be blamed for short- and medium-term pain. By the time the long term benefits come, the legislators who voted for it will be long gone, voted out by citizens angry about how Medicare got screwed up by the government. HilaryCare in 1993 led to massive Democratic losses in 1994. ObamaCare in 2009 led to massive Democratic losses in 2010. Would BernieCare in 2021 lead to massive Democratic losses in 2022? Yes That's why Gov. Shumlin gave up.

  16. @Seth Rogoff The author works for a right-wing magazine funded by the Kochs and Scaifes, so this is no surprise.

  17. @Tom Meadowcroft So you are arguing that people will forever and always vote against their interest. But there's plenty of evidence that such a permanent gloom is not inevitable: People supported the introduction of Medicare under Johnson and it has become more and more popular. Nixon did not run against Medicare and no winning candidate has done so.

  18. Goes to show that lawmakers are going to have to explain how medical care plans will be paid for. The time is now to start looking at the rest of the developed world, since they are already doing it, and see where it appears to be working most effectively.

  19. It's not only "assumption" that a universal health care plan would pay lower rates in the range of current Medicare rates, it's a fact. The implication that there's any uncertainty here when even libertarians at the Mercatus Center have admitted as much is shockingly misleading. Second, proclaiming that there shouldn't be greater political support for M4All because there isn't enough political support for M4All is a rather solipsistic argument. Other wealthy countries pay less and have much better health outcomes following the basic model being proposed. End of argument.

  20. There is no real commitment to improving health care in America. The wealth care industry has most of our lawmakers in its back pockets and they react accordingly. Yet we know that other countries spend far less on medical care than America does and that they have far better outcomes. What is never really discussed or acknowledged is that our entire wealth care system is like our justice system: we get the best health care money can buy. Not enough money, we can die or go untreated. Our system is not working. We have people unable to afford basic medical care even if they have insurance. There are chronically ill people who, if they take the right medication, can work and function. What's the problem: insurance companies that refuse to allow these patients to receive the care they need, that make it hard for them to get the medication, and then we have the pharmaceutical industry which loves to overcharge, underdeliver, and overpay its CEOs. Maybe there aren't enough people unable to work because they are unable to get the care they need. Maybe enough of us haven't died in the prime of our lives due to treatable illnesses. Or maybe the right people haven't experienced the stress the rest of us feel when faced with medical expenses that are necessary and unaffordable. Whatever the issue is it's not about health. It's about money and those who will not make as much if things are changed.

  21. I thought we could just tax the millionaires more, right? They're going to pay for everything: healthcare, college, housing, etc.

  22. They certainly should pay their fair share - which they currently are not. When working class Americans pay a higher tax rate than millionaires and billionaires something has gone drastically wrong with our democracy.

  23. How do all the other western nations accomplish this yet we can’t?

  24. @Scott American exceptionalism :)

  25. It's weird to read an argument against the medical system you've had all our life, the one that took good care of both your parents through to the end of their lives; the one that is similar to one that works as well, for half the cost of the American one on average, in many other countries. Mark Twain perhaps felt the same, reading those headlines that he was already dead. Sir, your reports of the impossibility of universal medical insurance are greatly exaggerated.

  26. Hard to understand this US debate. Medicare for all works fine in all civilized counties in western Europe. Why would it be so difficult in the US.

  27. @Henry To quote Upton Sinclair "It is difficult to get a man to understand something, when his salary depends upon his not understanding it!" In the US private profit for the few is prioritized far above the general wellbeing of the population.

  28. @Henry Healthcare as a business vs Healthcare as a service....

  29. @Henry Most countries in Western Europe do not have Medicare for all. They have a tightly regulated private insurance market that covers every citizen. Not the same thing. A government-financed and -managed system is the exception, not the rule.

  30. Mr. Suderman falls victim to the logical fallacy that the only acceptable solution is a perfect solution. The fact that Vermont's attempt at universal healthcare failed does not mean that all attempts at universal healthcare are doomed to failure. Other countries have successfully implemented universal healthcare. To say that we can't is to say that we are somehow less capable than these other countries, and I do not for a moment believe that.

  31. You can't draw a comparison between the efforts of a small state to build a healthcare system from the ground up with no buy in from other states, and the potential efforts of the federal government to expand a pre-existing program that has been been in effect for over half a century. Unlike Vermont's attempt, Medicare already has proven infrastructure and trained personnel in place, along with policies and procedures to use as a roadmap for a potential expansion. Any potential expansion of Medicare would not be starting from square one, as Green Mountain Care did, and would be able to piggyback on the existing infrastructure. As any first year political science student can tell you, it is nearly always quicker and cheaper to expand an existing program than it is to create a new one from scratch. This piece is at best, naively uninformed and at worst, actively misleading about the topic of single payer healthcare.

  32. @Kara Reason magazine is a libertarian leaning (to be generous) publication and should always be taken with an unhealthy grain of salt

  33. @Kara You are aware that our existing Medicare program is not at all what Bernie is proposing. Only the name is the same. Medicare does not provide health care nor employ health care providers. It doesn’t cover everything and most people rely on private insurance to fill the gaps or purchase Medicare Advantage plans through the private insurance market. What Bernie is proposing, elimination of private insurance and health care provided by the government IS starting from square one.

  34. It's going to become workable one way or another, because health care is beginning to price itself out of affordability for nearly everyone, even the upper middle class. The rest of the developed world has abandoned a for-profit system because it simply isn't affordable. We're the last hold out, and our grip is slipping.

  35. "But if it couldn’t work in Vermont, with a determined governor, an accommodating legislature and progressive voters, Mr. Sanders will have a tough time explaining why it will somehow succeed on a vastly larger scale." Very true. And campaigning on health insurance is no way to drum up the vote. Most of us would prefer to avoid the topic altogether because implied within the health insurance issue is the undeniable but almost-eternally avoidable fact that we all will eventually get sick, old, and die. When a young Siddhartha came to that realization, he abdicated from the throne he was about to inherit and instead dedicated himself to achieving enlightenment and great separation from the bummer of a conclusion that life is suffering. Political campaigns at their best are hopeful and inspirational. Health insurance is one the great drudgeries of modern existence. It's too reality-based and, yes, the Vermont voters were stoic and mature enough to sift through the numbers and in the end give the single payer option a thumbs down. However, it's plain to see that the Democrats running for president had better take heed. It's not only that people don't want to change a plan that already comes with so many changes each and every year. It's simply that we'd rather not think about it at all.

  36. Sigh, another "horseless carriages will never replace the four-in-hand" argument. The orderly transition from today's ultra-expensive and exclusionary (but profitable) medical insurance system to something that actually benefits patients and their pocket books is not an easy one - especially considering the volumes of misleading opposition from those who will lose the public base of wealth when it happens. The simplest way to effect this is to simply remove the "age of 65" provision in the current Medicare legislation.

  37. This article ignores the chronic impulse to lower taxes on the wealthiest people and corporations in the nation even when the tax code has more holes for the wealthy than a colander has for pasta. Our health care system worked best when the wealthy pay taxes at about seventy percent. But most of all we pay private insurers half our premiums to cover their overhead and investments while Medicare for instance has an overhead of three percent. The politics of national healthcare has far outstripped the economics for complexity. What happened in Vermont isn’t irrelevant but it’s not very useful either.

  38. "Lack of political" support isn't a great argument against a good idea. It's simply an explanation for why getting something to happen may be difficult. And glossing over something like "losing private coverage" is another example of a writer's bias coloring his description - losing private coverage means you lose your insurance company; who cares? We don't get healthcare from our insurer; we get confusing statements, denial of coverage letters and lots of odd bureaucratic communications that only add to confusion. You lose your private insurer and instead, you get to go to the doctor when you need to with a minimum of hassles or dealing with bills or complaints. And to all those readers unfamiliar with it, "REASON," the writer's publication, is a libertarian rag - of course they're going to argue for the outcome they want - the status quo.

  39. A single-payer system might fail in the U.S. now because of a lack of trust and political will, but single-payer models work all over the world. The model is not the problem. What's needed to change political will is clarity on the details. Of course it will raise taxes, but that should be offset by the elimination of insurance premiums. Once people are willing to take the insurance company middle-men out of the picture, and once all the details are on the table, Medicare for all should be an easy conclusion.

  40. This is not any kind of proof that single payer wouldn't work. Did Vermonters all stop paying private insurance premiums as the Health Tax went up? Wouldn't that be a great savings? Shouldn't that be included in an honest discussion about funding healthcare? What is so bad about private insurance disappearing? How is that a negative? Were costs contained in any way or did the state just pay for whatever was ordered? Medicare does pay less for things, but the outrageous costs are the problem. Medicare is trying to rein that in. Whats the problem with that? Why is it that single payer seems to work in so many countries? Why is it that non of these countries is trying to shift to our system?

  41. I am a Medicare recipient and think the system works just fine. However, whether such a system would work on a much larger scale is unclear. Medicare does operate at a lower administrative cost, but the major expense in health care services is not administrative costs, but what is paid to health care workers and hospitals. Compared to other OECD countries, average health care costs in the U.S. are significantly higher than in other countries, where health care outcomes are frequently better. Its worth remembering that a dollar paid on health care is a dollar of income to someone. The antidote often cited is increased competition that somehow magically reduce health care costs. Unfortunately, health care services are not like televisions and its almost impossible for the average consumer to make any meaningful comparison of health care costs and services, especially in an emergency when decisions must be made quickly. Medicare could be more efficient if given greater authority to negotiate prices. However, as long as the remainder of the health care market remains fragmented, its going to be difficult to negotiate significantly lower prices, nor is it likely for health care workers and hospitals to willingly work for less pay.

  42. @Scott B Some if our dollars go to supporting the giant billing overhead seen in the American system. The constant dance between insurer and hospital cost about 10% of you health care dollars. Besides Healthcare as a business will always be more expensive than the rest of the worlds healthcare as a service.

  43. And who actually loves their private insurer? Does anyone love private insurance? I don't wake up every morning and say, "Alright, I get to have a call with Blue Cross today!"

  44. @masayaNYC I'm now on Medicare & have had private insurance for the rest of my working life. I don't "love" either system. But have been "satisfied" with both, since (key here) I haven't had any unusual or extreme problems But I did find my private provider more responsive to issues with claims,etc. Medicare (800 number) won't even allow my contacting the processor of my claims. They just say - "Just resubmit", and maybe it will work this time. Any intimation that Medicare for All will be painless & frictionless need a reality check.

  45. @masayaNYC LOL, and every time I DO have a conversation with BX, I end up telling the poor phone rep on the other end of the line, that THIS is why people hate our current healthcare system and want single-payer so badly!

  46. What makes most sense is reducing the cost of health care. The reasons for the excessive costs need to be identified and policies need to be designed to lower those costs. There has to be good reasons why health care costs are so high and it is clearly not just because of insurance company profits and the cost of drugs. The entire system needs to be analyzed with a particular emphasis on hospitals.

  47. Universal single payer health programs have worked very, very well in most of Europe, parts of Asia, and Canada, but Mr. Suderman thinks that the Vermont example dooms any success in the US. Those of us who have lived and worked with a national single payer plan cannot wait to see it here. However, there are far too many profiteers in the medical care industry who are fighting tooth and nail to preserve the hundreds of billions of dollars they skim from the system every year without providing any care whatsoever. Let's be 100% clear----the issue being discussed is not what is best for economical, safe, fair universal health care----the conversation is driven by those who wish to preserve private profits, and will lie and deceive shamelessly to preserve those dollars.

  48. No one said it would be easy, but if at first, you don't succeed...

  49. @chairmanj ... yes, quite good as liberal mantra to divert attention from failure.

  50. There are major problems with this analysis by Suderman. First, Medicare for all will result in EVERYONE receiving health care. Furthermore, everyone will be receiving the right health care, because they won't be worrying about how to pay for it. This will result in a healthier society, which will result in tremendous benefits, both for the individual who is being treated, as well as the society at large, with many positive externalities. So if we are doing a cost-benefit analysis, we have to recognize the enormous benefits, which Suderman doesn't do. Second, we have to remember, the "costs" of health care are actually the incomes of the health care providers. With Medicare for all, no longer will we have wasteful spending in the form of PROFITS for hospitals and insurance companies. The drug companies will still earn profits, but they will be curtailed. Third, we have to remember, which Suderman neglects, that the money we spend on health care stays in the economy and circulates in the economy, so the notion of "costs" is actually a misnomer, because the "costs" are going to be the incomes of other people within the same community. Of course, because it is a public system, Medicare for all would have to have strict accountability. But we've proven that we can do that successfully already with our current Medicare. The right wing, of which Suderman is a part of, does not like to hear this kind of analysis, and neither does the Times, which prefers the right wing.

  51. Vermont failed in going to single payer for many reasons as outlined in this op-ed but chief among them was overreach. When Social Security was passed in the 1930's, benefits would be paid for about 13 years for those who reached 65 and this has grown slowly since then to less than 20 years by 1990. But aside from disability and survivor benefits, Social Security only covered a small piece of the population. Medicare for All is such a large jump in coverage (and with that cost) adjusting for that change would be like trying to eat all your meals for a month in one sitting. Medicare for All could much more easily make the change if it started as "Medicare for Any", not compelling but allowing signups at progressively lower ages over 5 to 10 years. If it worked, popular support would rise in like measure. How do you eat an elephant? bite at a time...

  52. @Doug McNeill Yet somehow, industrialized nations around the globe are managing to "eat the elephant" whole. Incredible that people are continually making up excuses for America's failure to manage the same. Eliminate the PROFIT-MAKING middlemen (insurers) from the equation, and Im sure we could care for everyone -- perhaps at less money than we're paying now.

  53. Failure in Vermont might actually be an aurgument FOR a national fsingle-payer system. These sort of systems are sometimes more economically and efficiently run at a large--i.e. national--scale. It is difficult to set up a system in a small state like VT when doing so goes against how its set up everywhere else. Also, public support will likely increase in the future. Maybe not enough people support it now but I bet the numbers will look really different in 5-10 yrs.

  54. @Itsy This argument that "if we just scale it up to the federal level, it will all work out" reminds me of the hopeless widget producer that loses money on each widget, but is sure that he will make it all up on volume.

  55. I think that most people need clinic care first, then possible additional care after that, as needed. I don't believe that a homeless drug addict should have a heart transplant before a person who has contributed to society. The clinic care would ease the congestion, as well as high cost associated with the emergency room. Each phase could then be evaluated for need. People with health insurance would rely on their personal insurance for their coverage. Seniors would use Medicare, and any additional insurance. Just saying.

  56. @Dan O Wow. Who's going to be serving on this panel to determine who's "contributed sufficiently to society" to merit health care? And have you considered that the homeless drug addict might not be homeless nor an addict with adequate and affordable health care to begin with? What a heartless plan! Just saying....

  57. I've lived most of my life in Canada, some in the US, and some in New Zealand. In Canada, in my province, Health Services run at about 6500 Canadian dollars per citizen per annum (5000 usd). Included in that are subsidies for citizens on pharmacare. System works pretty good with some exceptions: 1. wait times on optional surgery; you might wait a while for that hip operation. 2. wait times on diagnostic services 3. No 'favourites'. There are now avenues to purchase special privilege in terms of reducing wait times. Note that independent of whether U.S current system, or Canadian system, a large amount of money is spent on 'people who would have got better even without seeing doctor' or 'people who are in last 6 months of life'. I cringe when I hear the US stories (cost to have a child or an operation), and though not totally happy with our system, see the virtue.

  58. @me Exactly! And they still get care. Just pointing out the facts with regard to expense. On the other hand, costs can be decreased on 'persons who don't really need care', but are processed at a cost, by having non-doctors (but certified nurses) provide first line of care and reference to specialist. Additionally in our system diagnostic measures are taken to reduce tragedy. For instance, since my father died of colon cancer; I go for regular, efficient colonoscopies, as part of the system.

  59. Even if you accept the assertion that Vermont's attempt to deliver "Medicare for all" was a failure, it hardly represent a bellwether. Vermont is a tiny rural state of fewer than 650,000 people and represents less than two-tenths of one percent of the US population. Even if it were a representative sample and case, it says nothing about whether we should try to do better. To say it is hard is obvious. To say we shouldn't try because it is hard runs counter to American values, history, and the very notion of progress. Why was this letter even published?

  60. I have always thought the simplest answer is "Catastrophic Insurance For All" where the government pays for anything over, lets say, 50k. The private insurance market would open up to millions of more people because covering the amount under 50k would be as cheap as car insurance. If not cheaper. Hospitals would love it because they would no longer have to eat the uninsured that have heart attacks, etc. The bankers would love it because it would nearly end all medical bankruptcies. Lets think outside the box!

  61. @Gdog I doubt that most Americans feel they can afford to pay $50,000 per family member per health event! Back to the drawing board, I think...

  62. One big cost driver in establishing a single payer plan in Vermont is that we are a tiny state with only 600,000 plus residents. Our population is aging, and there are fewer workers as a percentage of the population than there is nationwide. A single payer plan here could not surmount the obstacle of insuring a relatively small group of people at a reasonable cost. This is why Obama-care originally included the mandate to carry insurance - it spreads the costs widely over people throughout the nation, rather than concentrating them on a small segment. That's how insurance is supposed to work. The healthy pay now to be covered when they are not so healthy. Otherwise we are just pre-purchasing medical care.

  63. National health insurance solves a problem the individual consumer can't. Namely, individual consumers cannot negotiate prices for treatment. Especially when they're sick. The only way the consumer can compare insurance products is to look at the sticker price. But insurance is a massively complex thing - how the insurance company arrived at the sticker price is an opaque mystery to the consumer. Also, unlike many other products, cost is not an indicator of quality. There's this throwaway line in the story that bears this out: "Legislators in Washington State started with the same assumption when they attempted to design a state-managed insurance plan, and it proved wrong. The plan passed only once rates were increased." Maybe I'm a little old school but ... isn't this what politics is for? Negotiating things? Solving difficult problems? Making compromises? Reasonable people disagree all the time. So maybe Vermont's failure is not as illustrative as the author suggests? In Vermont there wasn't the kind of room for political compromise that seems to exist in Washington state. But that's no reason to assume Vermont's constraints apply at the national level. And in fact, I doubt Vermont's constraints would apply at the national level. We do have Medicare, Medicaid, and SCHIP after all.

  64. Mr. Suderman works for a right wing web site with the absurd post modern name of of Reason. His single "reason" why medicare for all won't work is a variant of the argument used by conservative Democrats and Republicans that opposed Social Security in the 1930's. It is the ur argument that stone age men probably used against those who tried to create a fire by rubbing two sticks together. The "it won't work" argument that did't work in Europe and China where government health insurance has worked well for years. It's an "unreasonable" argument.

  65. For an editor at Reason, Mr. Sunderland is careless with logic; "(t)he first problem for any single payer plan is political." A political problem is not endemic to a single payer healthcare system. What is the first problem with gun control? What is the first problem with climate change? The first problem with single payer healthcare in the U.S. is greed and lobbying money. And everybody knows it.

  66. @Alex Mr. Suderman. My apologies for the error.

  67. The ACA didn’t happen overnight, nor seamlessly. It took many years and many tries before there was the will to move forward and courage by Congress to pass it. This article’s conclusions are false. Not enough debate has taken place and most people don’t fully comprehend the contours of Medicare for all, perhaps with a choice to opt out. Vermont’s serious debate is a courageous first try for them. The main thing is that it’s in the public’s consciousness.

  68. Others have already mentioned this, but I will concur a little more explicitly--the attempt at universal health care failed in Vermont primarily because as the state ranked 49th in population, the coverage pool was simply too small to balance out the cost. (It probably doesn't help that Vermont has a higher percentage of older people in its population as well.) But, on a national scale, with a huge coverage pool, economies of scale, and the ability to piggyback on an already existing administrative structure? That's a whole 'nother thing. The biggest problem there is the political resistance caused by the various medical lobbies and the disquiet people have about not being able to keep private insurance they are comfortable with--which is why the compromise position is public option/Medicare for all who want it, which can be instituted quickly, and, if it proves cheaper and less difficult to navigate than private insurance (which, without a profit motive, is likely) will eventually become the most dominant choice. And breaking the link between insurance and employment statuses will likely spur a lot of entrepreneurial activity as well.

  69. @Glenn Ribotsky First, a "Medicare Option" must be 100% self supporting. I.e., subscriber premiums, perhaps subsidized for the needy just as private plans are through the ACA, must pay 100% of the medical and administrative costs. It turns out, that once you remove the government contribution to Part B costs, pay full Part A premiums, buy a good supplemental plan, and part D, total premiums in my area would be over $1,000/month. If those opting in are in average health for their age, their premiums would be somewhat less as most such participants are under 65 which is a healthier cohort than the current Medicare cohort. However, if the sickly gravitated towards the Medicare Option, premiums might be higher (almost everyone over 65 is in Medicare so they get both the healthy and unhealthy). Note that even with these high "actual" premiums, the lifetime limits on coverage of hospitalization would remain in Medicare (which, for some reason, was conveniently excluded from the ACA's ban on such limits - interesting when the rulemakers don't apply the rules to themselves). Second, the "Medicare Option" must be something doctors and facilities can opt-in/out of independent of regular Medicare. There are already many areas where finding a doctor to take new patients on Medicare is very difficult and seniors on Medicare will kick out politicians if they expand the demand for those doctors making access more difficult for the retirees.

  70. What a load of crap. We have plenty of money, and a country full of rich people who don't pay their fair share. What about cutting some defense budget? How about raising the cap on Social Security, so at least rich people pay the same rate as our lowest wage earners? Negativism never solved a single problem, and it never will.

  71. The author ignores the fact of State political borders. The reach of the Vermont single payer program did not extend to New York, New Hampshire, or Massachusetts. As a result, the main benefit of the single payer system - the power to control health care costs - was lost. Providers could simply opt out of the Vermont program and provide service over the State border 20 minutes away from almost all of the patients in Vermont. The better example is ... well, the actual Medicare program, which administers more than 20% of all healthcare spending in the United States. The Medicare program has done a remarkable job of controlling costs and promoting high quality care for the over 65 population of all Americans. It is time to extend the success of a program that has worked well for more than half a century to all Americans.

  72. Why is there no mention of the billions of profit made by the health insurance cartel?

  73. I'm shocked, shocked I tell you, that a former writer for various libertarian/conservative think tanks would cherry-pick this single case. The argument presented is low on hard data, high on opinion and fails to recognize the success that single-payer has had elsewhere throughout the world. Any number of other case studies could have been brought in for an honest comparison. For instance, a NYT article from less than 2 years ago takes a much more unbiased look at how Taiwan's implementation of single-payer went: ( One of the reasons cited for Vermont's failed implementation was the unstable economy. Despite early shocks to Taiwan's economy (Trump's only "accomplishment"), it stabilized over time. I'll take short term pain for long term solutions any day. I thought that this was a country of big ideas, one that supposedly can tackle any challenge. Private healthcare has had plenty of time to figure this one out, and it's simply not working. If American really is capable of being the best, it's time to start acting like it and stop listening to cowardly writers with their supposed "strongest arguments".

  74. By rights the U.S. should be at least on a par with other 1st world countries when it comes to health care, and that means single payer. This article may be rendered meaningless if a progressive democrat rides the wave of disgust this administration and its enablers in the Senate generate, into the presidency, as well as a majority in both houses. The backslide the country is in the midst of may provide the right climate to right a lot of the corporate wrongs.

  75. @shredder Switzerland and Germany are not single payer. The health care in single payer countries is adequate but grossly different from what we have here. Americans will not like it. Too many limitations. The results per dollar spent may be equal or better, but that is because they say "no" to things that don't work. Try telling a medicare recipient that they are too old or too sick to "try everything." Won't work without a major attitude change.

  76. @Ny Surgeon I'd support a system that tells a medicare recipient that medicare will not pay for something because they are too old or sick to try it. That doesn't mean the person can't proceed to try it - they would just have to pay for it themselves.

  77. @Ny Surgeon "The health care in single payer countries is adequate but grossly different from what we have here." That is nonsense. I suggest you come down here to Monterrey and see for yourself what our first-class cardiac hospital does. I had open heart surgery and angioplasty. Cost to me? $ZERO.

  78. Suderman is a libertarian -- which means his base beliefs comes down to money which is far more important than people. These systems can work, but Suderman can't make any money off the carcasses of the poor.

  79. So what? Even if this argument is valid (which I doubt), we're supposed to live with the broken system that we have now? The central problem is greed in system dominated by ghouls that exploit, rather than care for the sick an dying. The USA spends TWICE per capita and gets poor results. How about the NYT publishes some valid alternatives to Medicare for All instead of constantly criticizing it and siding with the ghouls.

  80. Warren and her mentor, Bernie, want to outlaw private health insurance. Warren, especially, refused to admit this during the last debate. she knows it will turn off many people ( like me and my husband). She and Bernie are so far left of center that they will never carry the midwest and certainly not win a general election. Mayor Pete has a much more reasoned, less fanatically left position. Medicare for All who want it. If it is so great, which in practice it won't be, citizens will embrace it. And the twins also are very evasive ( read dishonest) as to how it will be funded and whether middle class taxes will rise ( they will according to almost every economist). Mayor Pete will end up as the nominee and defeat Trump.

  81. @simon sez You like private insurance companies? To me, in all forms of insurance, they define the term “necessary evil.”

  82. @simon sez Traditional Christian and Democrat values dictate that there should be me3dical care for all at a fair price. Clinton tried.. his other policies were very Reagan influenced... Obama went Republican as well with Romneycare Do you really care if the luxury tax on super expensive things- art, yacht, private planes, fur coast were reinstituted? There are methods of taxation that are not regressive. (Are you really happy with the Trump tax cuts? The money is here, but in certain people's pockets esp. those in real estate which ps is used to launder money from many nefarious activities -- drugs, prostitutions, gun smuggling, gambling, theft -- to name a few.

  83. @Paul if they are necessary, they are not evil. Do you know how actual universal coverage works in Europe? I do; and I agree with @simon sez. There isn’t a single European country in which private insurance is outlawed. The idea is not simply unworkable; it is outrageous.

  84. That something is politically controversial is not a valid argument that it is inherently flawed or untenable.

  85. Democrats need to learn how to sell things. The way to keep the Sudermans of the world happy is to introduce Medicare for all who want it and give a "Tax Break" to all who keep their private insurance. The private insurance will wither on the dead vine it grows on and the insurance companies will prosper selling the supplemental insurance most Medicare recipients buy now. It's the American way to find a way to profit off of offering better.

  86. This is an irrational argument. Medicare is already a successful healthcare insurance system, covering 44 million people. Medicaid covers 75 million. That's close to a third of the American people. The only thing that the failures of one-state systems proves is that one-state systems are not feasible. They're too small and don't have the necessary legal leverage. That said, I think that a public option (Medicare for Those That Want It) is a better option. It will be politically more popular, since people don't like to have the government coercing them into unfamiliar territory. The public option was left out of the Affordable Care Act because the healthcare insurance industry was afraid that it would be too popular. If they're right (and this IS their business), it will become Medicare for All over time without coercion. And that time will allow the system to evolve to meet the needs. It should also be kept in mind that the healthcare insurance companies will not be put out of business. They currently process all the claims from Medicare and most of those from Medicaid under contracts with the government. It would be chaotic (and pointless) to have the Federal government take over those functions.

  87. @David The public option was left out of the ACA because the Democrats had exactly 60 votes, and zero Republican support. Max Baucus, then the Chairman of the Finance Committee wouldn’t move the bill until the public option died. Guess who is a wee-heeled lobbyist now? Baucus.

  88. So the strongest argument against single payer is that the Vermont experiment was a failure? If Canada, France, New Zealand Germany the UK Japan etc... can do it then the strongest argument against it remains "because we don't want to."

  89. @Mike Germany has a universal multi-payer health care system paid for by a combination of statutory health insurance (Gesetzliche Krankenversicherung) and "Private Krankenversicherung" (private health insurance).

  90. @Mike And who knows what kind of pressure was applied behind the scenes to ensure its failure by those who stand to lose if our for-profit system is replaced.

  91. @R. R. - In order to opt out of the national plan in Germany, you have to earn above a certain limit. Many of those who can opt out, stay on the national plan. Only 10% opt out.

  92. I still think single-payer will work on a national scale. Think just of the enormous collective bargaining power the US would have against Big Pharma. One caveat: If everybody gets “free” health care, I want the money I put into Medicare refunded to me.

  93. @Anonymous: Your Medicare contributions paid for the generation ahead of you. If we did move to single-payer, it would presumably be funded by payroll taxes and income taxes (like pretty much everything else) so your healthcare would be paid for by the generation behind you. Why would you get refunded? Incidentally the current retiring cohort paid on average $90,000 or so less per person into Medicare than they will receive in care. Just something to keep in mind when asking for your refund.

  94. SURPRISE! Another statist notion dreamed up in the shower, using other people's money goes belly up. Gee. Just wait until all those government pension promises dissolve into the ether. Then you'll really see what resistance means.

  95. And you know what is absolutely incredible? Canada, Britain, France, Germany, Norway, Sweden, Denmark, Belgium, Holland, Italy, Ireland... Somehow they all manage the impossible! How do they do it? It must be magic! Oh, if only we knew how... Sadly, we shall never master this magic, it is simply beyond poor little America...

  96. Is it too much to ask the Times to reveal that Reason magazine is funded by the Kochs (David Koch even served as a trustee of the publication), and that Peter Suderman is a long-time financial beneficiary of the Koch brothers, as is his wife, Megan McArdle?

  97. From which health insurance company is Mr Suderman getting his junkets? There are 3 problems with this analysis. First, Mr Suderman and all the other naysayers never mention all the people who die every year because they have no insurance. The current employer-based system DOESN'T WORK--unless you consider a system as working that leaves 1000s of people to die every year for lack of coverage, and leaves 80 million people with little or no coverage. That's like saying the NBA was a more talented league before black people were allowed to play. Second, they never mention that the current system will die out eventually anyway, because tens of millions of people simply can't afford it, and it's getting much more expensive every year. Finally, it assumes Americans are idiots, because for some reason all the other advanced countries have figured out a way to do it, but we're just not bright enough to get it done here in the USA. There are numerous examples of how it can be done--first we have to get Mr Suderman and his friends in the health insurance industry to pack their bags.

  98. Brit, here. Lived in NYC 20 years. Was on my ex’s union HMO plan for years, zero problems..... Now a contract attorney, uninsured, and the cheapest employer healthcare monthly premium is $850 a month with a $6,000 deductible. For out of network costs, I would have to pay $1100 a month. Wish I had stayed in Britain where it was ALL free of charge, despite the fact the Brits pay about the same in monthly income tax as I do in NYC. Am I dumb for staying in the US? Or are people dumb in the US for paying 40 to 45% tax (including City tax for living in NYC) and not demanding the same free care the NHS offers? I will ponder these questions for the next 7.5 years until I can move back to Britain. I will tell you this: I consider the US an inhumane place to live; life here is nasty brutish and short, for most. I do wish people would stop helping the health insurance companies make a profit, and care more about their neighbors. But that’s not the American culture. How I miss the British one. People are kinder and happier there; they can afford to be. I actually sing the British national anthem when the American one comes on tv and at road races. I can’t stand the parts in the American National anthem about bombs and the glory of war. God bless the rich in Britain for letting me have free health care as a kid. I will sing that British anthem until I die, because I was never afraid of getting sick until I moved to the US. The rich here don’t have a conscience like the British rich do.

  99. "Like Mr. Shumlin, Mr. Sanders is a devout single-payer supporter who has campaigned aggressively on the idea." Shumlin isn't devout about anything except for Shumlin. He knew he'd have Scott the "moderate" Lt. Governor running against him and thought the only way to win to abandon single payer. In order to become governor when he first ran he had to pay lip service to the issue in order to bring along the Vermont Progressive Party, an influential third party in Vermont. To use this example is just dumb. The author googled a couple anecdotes from the internet and made a column out of it. He doesn't seem to have contacted anyone in Vermont about the issue. He writes for Reason a magazine of the "free market" (Check out John Stossel's interview with Glenn Beck!) Bad enough the free market is pouring millions into defeating Medicare for All. The Times is paying columnists to do it.

  100. Begs the question: How many B-2 bombers would we have to sell to pay for it? (not many one suspects)

  101. I see your example of Vermont, and raise you the rest of the developed world.

  102. @qda The article wasn't about if an institutionalized MFA system would work; it's about the ability to change over to one.

  103. @qda Most of the developed work, including most of Europe, does not have single payer health care. Do your homework. They get to universal coverage through hybrid systems with more choice.

  104. @Michael Cameron I just got back from Denmark, visiting my uncle. They have free healthcare but it's not a "hybrid" system as you put it. The citizens pay for it by paying higher taxes but no one complains about it.

  105. Headline: "A deep-blue state’s failure to enact a single-payer system shows why a national version is UNLIKELY to succeed." "Unlikely is misspelled" should be "NECESSARY"

  106. Where is the incentive to live a healthy life? That is one of the big problems with socialized health care -- we are being taken for a ride by those who won't lift a finger to save themselves.

  107. @The Ghost of G. Washington no one is purposely living an unhealthy life under the current privatized system, and no long term financial incentives are provided for living a healthier life. The system already accounts for the burden of those who take up less healthy lifestyles than others. Your argument lacks a basis in evidence supported by data rather than anecdotes, just like Mr. Suderman's article.

  108. @The Ghost of G. Washington What incentives do the French, Germans or British have? And yet they all spend far less on health care than the US does. With universal coverage under single payer systems.

  109. A single-payer system works in other developed countries because costs are much lower than in the US. If single-payer is implemented in the US without reducing costs, not much will change, only revenue streams will be rearranged (e.g. exchanging premiums for taxes). That's what happened with Obamacare, which resulted in dramatic increases in premiums, co-pays, and deductibles for working middle class Americans in order to perpetuate the problem of costs. Previous NYT articles have identified that exorbitant costs of medical tests and procedures represent our major problem, but it requires political courage to address costs.

  110. In Vermont, I assume that people with federal single payer Medicare coverage are not asking to have it ended. So it works for those over 65 - but not for younger people ? The Canadian system started in Saskatchewan and it became national as it succeeded. So, Vermont needed better resources but it would win out based on that model. In Canada, even the conservative party supports the universal provincial health plans - the public likes what it has and employers are relieved of a great burden.

  111. Medicare works because, covering older citizens, it has roped in the segment of the population with the highest healthcare needs. Further, one pays into the system for as many as 47 years or more for coverage that lasts a much shorter period (13 years with avg life expectancy at 78). In addition, Medicare is virtually mandatory since those who do not sign up at 65 are penalized (with certain exceptions). Given these factors, how would M4A or for those who want it compare?

  112. The main lesson from Vermont is that no single state can enact a single-payer system on its own. That's not really news. Vermont's problems do NOT say that a nationwide single payer system would have the same issues.

  113. I don't deny Vermont failed to put Green Mountain Care into place, but some of the assumptions they put in--including items like covering people who lived elsewhere but worked in Vermont--raised the rates in a way that would not happen under a federal plan. More to the point, we have dozens of countries with universal healthcare we can learn from, and that's something Bernie and the Democrats (that's also my political rock band name) encourage. Even the ones that are less successful and uneven in coverage, on average, provide better for their citizens than we do--at a fraction of the cost. Saying one small state providing healthcare to all its residents and its visiting workers is proof why a federal plan covering all residents absolutely would not work is a very weak argument, and I am surprised you tried to make it.

  114. Medicare-for-all is possible, but not all in one big bite; it needs to grow organically over time. That is the advantage of the Medicare optional buy-in concept first proposed by Sen. Ted Kennedy. It avoids the need to construct a huge new program all at one, with all the attendant legal, financial, political and administrative obstacles, which are prohibitive. Instead, it will grow gradually enough for the health care industry and the public to adapt. If we were starting with a clean slate, such a big bite might be possible. But we have a big, complex existing system, and like the proverbial ocean liner, it can’t be turned on a dime. So, instead of arguing unproductively for and against such a new system, we need to recognize the issue of SCALE, and bring that to bear on a more thoughtful and realistic national conversation.

  115. The focus on single payer vs. public option and private payers misses the point. Our neighbors manage to provide healthcare for all their citizens at much lower cost. Some use a single payer model. Some use private insurers with a public option. But ALL manage to insure everyone at much lower cost. The problem is the regulatory stance of the government. European systems are tightly regulated to protect the public interest. American medicine, where it is regulated, is regulated to serve the big money interests of Pharma, insurers, and big hospital chains. We have regulatory capture, they pay attention to public interest. It's that simple.

  116. So Dems have tried this twice, without the support of the federal government and with no help and active opposition from the GOP - and the author’s solution is to call it a failure and impossible to achieve. Meanwhile, my guess is the author probably still endorses continuation of Reagan era “trickle down” economics despite its proven failure even with consistent federal support.

  117. Ten years ago a lone small state could not re-make our health care system's abuses. Big Pharma was out of control, Medical insurance was out of control, and the money was rolling in, in unimaginable amounts quadruple the Defense Budget. We can pay for single payer, and have as much money left over as it costs us, after we stop paying for the abuses now robbing us blind. We can't get people to understand that, whose money is made by not understanding it. Those who are overcharging us to the tune of 8% of GDP tell use we can't afford to stop being overcharged. Yes, we can. We desperately need to be rid of that, and the people doing it. They'll fight to the bitter end, lying all the way, to protect that massive theft. A theft from us.

  118. Single payer is a fine concept but it would take many years to implement. This is a political impossibility unless you have control of the presidency and both houses of Congress for a sufficient time, which has never happened. Otherwise it will be like Obamacare, where Democrats had control for long enough to get it on the books and Republicans have spent a decade trying to weaken or repeal it.

  119. I'd prefer Medicare Buy-in for All Who Want It. And/or public option.

  120. Here is the silliness of your argument on a national level: 17.8% vs 9.6%. That's the US GDP spending per capita on Healthcare vs the OECD average. Broken down into a $22T economy where the share of Fed/State/Local share of spending on healthcare is 50% means we spend $3.9T on healthcare vs $2.1T if we adopted the average cost of any developed nation. So let's go with the high end which is 11% on the Swedish model. The savings is $1.5T and the government share is $750B. Before Trump's latest tax cut would balance the federal budget and pay down the debt. So there is one reason to move forward. Next we want to export more. Burdening US businesses with the cost of healthcare vs paying for it in taxes would make our exporting more competitive. Next how to transition from our current system to a new government system means every business paying for healthcare provides a one time wage increase to every employee equal to the cost of healthcare. Moving forward it's a tax increase to employees like SS/MED. We are 10 years into the Obamacare era. Guess what? Conservatives/republicans still don't have a plan. Why? Because they believe everyone should be on their own. The only premise they can almost agree to is a high risk pool which never works and will never be funded. Put everyone in the pool just like major employers due.

  121. It can't be done state by state. One of the important (if not the most important) factors that makes Medicare for All (and, indeed, all universal government run programs) so efficient is that everyone is treated the same. You cannot do that in a state program. What do you do about the money people have paid into Medicare and those actually on Medicare? On Medicaid? TriCare, Indian Healthcare?, etc. The only thing they could think of in Vermont was to leave them out. Then an even bigger problem came up. What do you do about people who work for multi-state corporations? Would these be covered by the Vermont plan or by the plan the corporation has for all of its employees? Again they were left out. If you have a national plan all these problems never even come up. Here is the bottom line on costs: Canada has a system similar to M4A. In 2017, Canada spent $4,753 in PPP dollars per person for health care. We spent $9,892. That amounts to a savings of $1.8 TRILLION or 51% each and every year.

  122. @Len Charlap Was the $4,753 in Canadian $ or US$?

  123. @Allan - It was in PPP dollars which are US dollars adjusted for the cost of living in each country. The figures are from the OECD.

  124. If people don't get medical care they don't add to the "Medical Loss Ratio," an insurance term I find repulsive. Of course, we will spend more money as a nation if we take care of people's medical bills. Presumably we will have a healthier population, too, which will decrease costs in the long term (but not in the 24 hour news cycle which seems to matter more.) I hold that good health, not having as many preventable deaths, ability to find out what is wrong and treat it sooner, having less pain, treating depression, avoiding bankruptcy due to medical costs, and not lying awake at night wondering what will happen because of some medical condition has some value. Maybe that value doesn't show up in the board room, but it sure shows up in the living rooms across this country.

  125. Congratulations on the necropsy of a plan that failed five years ago. So...WHAT’S YOUR PLAN? Status quo? Tough noogies? “As the Cornell Policy Review noted in a 2017 post-mortem, the mix of higher-than-expected costs and administrative problems “fostered an atmosphere of uncertainty and distrust in the state government, turning a politically steep climb into a politically insurmountable one.” Vermont had to set up a whole new administration. Since Medicare’s administration is already well established, and functioning well, even to cranky old folks, that isn’t a problem, is it, Mr. Suderman? My issue with Sanders’ version of Medicare for All is that well, it isn’t really medicare. I have taken care of three elderly relatives, and am fast approaching medicare age myself. Medicare has premiums, mostly unseen by the elderly because the premium is deducted from social security before the recipient gets their check. Medicare pays 80% of usual and customary charges, not everything, as Bernie’s plan does. And that leaves a yuge niche for private insurers to sell medigap policies. United Health Care has made a great business out of doing that for AARP members, so it wouldn’t abolish private insurers, either. I would buy into Medicare as is, and buy a Medigap policy.

  126. A lot could be done if Republicans would get out of the way but they won't. Their job us to block any proposal that doesn't steer money to their patrons.

  127. Pure sophistry. As any Economics 101 student knows, implementation and cost efficiency are matters of scale. The Medical-Industrial Complex fears price controls and dwindling profits so its apologists cherry-pick statistics to scare people. The real contention is with Medicare because it does not coincide with a free market economy. If you think about it however, neither do the unregulated trusts of Big Pharma and Private Insurance. Pointing to the failure of a healthcare insurance program in Vermont is as specious an argument as criticizing West Virginians for not eating enough fresh seafood.

  128. At the outset of my business career over thirty years ago, I paid nothing towards my premium and complained about a $15/$25 primary/specialized co-payment. My annual out of pocket was inconsequential. Today, my family premium offset payroll deduction is a little over $10,000 per year and my other out of pockets costs run in the thousands. Dental has become another nightmare bill. The question to ask is why have costs gone up so much for the vast majority of medical coverage. Doctors made house call as late as the late sixties in my neighborhood in Queens, Dentists were not expected to be rich (my father and grandfather were DDS, not rich). Rampant capitalism and excessive greed are the reason for these seismic shifts in costs. Half of the electorate want change the other half think this is the only way. Better alternatives and options are always possible.

  129. Mr. Suderman writes: "But if it couldn’t work in Vermont, with a determined governor, an accommodating legislature and progressive voters, Mr. Sanders will have a tough time explaining why it will somehow succeed on a vastly larger scale." Maybe I'm missing something, but I think "it" -- Medicare -- has succeeded on a vastly larger scale, covering virtually all of the elderly in this country, as well as those with permanent disabilities and end-stage renal disease (leaving the younger and mostly healthier parts of the population to the for-profit insurance companies). Mr. Suderman also notes that savings from single-payer assume payments to providers at Medicare's rates, rather than the generally higher rates paid by private insurers. This argument implies that patients get some value, presumably greater choice, from the higher payments. Although it is true that some providers do not accept Medicare, it is also true that private insurance uses networks to limit choice, in many cases canceling any benefit of higher payments to providers. The elimination of networks resulting from adoption of single-payer would itself be a huge boon in terms of continuity of care, time savings for patients and providers, and simplification of the system. Single-payer seems to be the only way that our system will ever be able to control costs. I find it interesting that Mr. Suderman's strongest argument against Medicare for all is all but devoid of any actual defense of for-profit insurance.

  130. It is absurd to think that a state and a country should be considered similar enough to make the argument that Mr. Suderman is making. At least it should be absurd. States can't control their borders while nations can. Do Democrats really want to control the border is up for debate. Most every other rich democracy in the world has a healthcare system is more socialized than the system in the US. Most countries have similar results as the US with far lower costs. Anyone working with "Reason" should want a system that produces similar results at a lower cost. Put another way, IF it were possible, we could duplicate the UK system of healthcare and we could balance the budget AND even cut taxes with the money saved in the healthcare system. Why shouldn't a conservative or libertarian want to look into a system with the potential to reduce taxes AND balance the budget? But, again, my main point is that Vermont has no control over its borders and little control over its taxes since multistate entities can shift taxable income quite easily if the incentive is big enough. In other words, Mr. Suderman creates his own strawman and then thinks it is a great accomplishment to knock down the strawman he created.

  131. @Tom Wilson This is a valid point comparing state to federal government is a bad analogy. Especially when it comes to funding. "In other words, Mr. Suderman creates his own strawman and then thinks it is a great accomplishment to knock down the strawman he created." Republicans do this all the time.

  132. Medicare for All is just political foolishness at this point. But a Medicare option in the insurance exchanges would be a tremendous step forward. Allow individuals and employers to buy into Medicare, at cost, as an alternative to private health insurance. And meanwhile, give Medicare all the power it needs to negotiate prices with drug companies just as it negotiates with doctors and hospitals over rates. The Medicare payment framework is already built and it is probably the least dysfunctional part of the American health care system. Doctors and hospitals may not love Medicare reimbursement rates but they can break even. Medicare might be cheaper than private insurance, or private insurance might be cheaper. If private insurers think they can be more efficient than Medicare, this would be a chance to prove it

  133. So, then people not qualifying for Medicaid can wait until they are sick to buy into Medicare?

  134. "... One reason the plan lacked strong support was lawmakers were cagey about how to pay for it. …" Healthcare as percent of GDP: USA: 17% every EU country: 10-12% The question " how to pay for it." needs to be replaced by "what to do with the massive 5% of GDP savings" The drag on the US economy that is the 5% GDP of the extreme overhead to compensate the C-suite, shareholders and the massive private bureaucracies needed to manage the byzantine array of policies, policy options, who has a pre-condition, who to cap, who to apply rescission to, etc.... would finally be eliminated. Just imagine this 5% of GDP could do if it instead was targeted to education, infrastructure, and scientific research.

  135. @oldBassGuy Or just letting people keep 5% more of their own money, which would increase consumer spending and grow the economy.

  136. @oldBassGuy Indeed. And imagine the entrepreneurial genius that would be unlocked if people could quit their jobs to start their own businesses without losing their health insurance!

  137. Mr. Suderman's argument is misleading. The US already HAS a medicare system in place while Vermont did not. Medicare is fabulous; ask any senior. The one flaw is that some practices do not take medicare patients, for example, the Mayo Clinic. This should be fixed by legislation. Doctors are licensed by the state and should be required to accept government insurance. Medicare can be easily extended to all by gradually lowering the eligibility age so the system does not become swamped during the transition. Taxes, both individual and corporate would rise, but not as much as individual and corporate contributions to private insurance as private insurance profits are eliminated and fees are negotiated by the government. Unlike Bernie, I have no problem with private supplemental insurance as this IS a feature of current medicare. Perhaps in the future, this would not be needed. Medicare works! Extending it makes sense. Additionally, people in the US are quite mobile; they change jobs and they often move to different states. Such moves currently place a HUGE burden on those who must re-establish their medical plans. Comparing a state, that doesn't have Medicare, to the Federal Government that does, is misleading.

  138. Arguing that politics will be the strongest reason for Medicare for All to not be enacted is fair. It will be extremely difficult to pass, that's true. But just because Vermont had difficulty doesn't mean a national plan would fail. Medicare has been working reasonably well since it was enacted more than 50 years ago. Surely if it were expanded it could still work just as similar plans work in every other developed country in the world. We need a leader who genuinely believes in universal healthcare and can get the public to buy into it. With public support it will be able to get through Congress.

  139. Medicare for all veterans (as an option in addition to VA) today. Bring the rest of us in as this step proves successful. That's politically possible, and will build support and confidence for the system.

  140. “Like Mr. Shumlin, Mr. Sanders is a devout single-payer supporter”. But Governor Shumlin is different; he was actually able to say: “I have learned about the limitations...” and admit that his plan cannot be implemented. Senator Sanders is cut from a different cloth; he will never admit he is wrong or that he needs to learn, and he will not change the subject. Millennials apparently take that as a sign of “authenticity”; those more old-fashioned see it as simply fanaticism.

  141. It will take us a decade or more to transition to something resembling Medicare for All. No amount of hectoring American surgeons and other key stakeholders within our current system will get them to suddenly begin thinking and acting like Europeans or Canadians. It's just not going to happen; there's too much money involved, and few people gladly embrace a significant cut in their income. This is going to be a process. That's the reality. The Federal Government will likely need to take a strong hand in training (and setting the financial expectations for) the next generation of medical professionals for this to work. If we can at least reduce the role of the for-profit insurance industry to that of a bit player, and remove any bar to the Federal government both negotiating with pharmaceutical companies and producing its own generics where and when appropriate, we will have had a gigantic impact.

  142. If congress would return to their roots as an august, deliberative body they might save us. Instead, I see a collection of tarted-up street-walkers without an ounce of morals.

  143. We've all heard the arguments against Medicare for All for many many years. Same old tune every single time. "Vermont couldn't do it!" "Somebody's gonna get something for free!" "Why should we give free medical care to brown immigrants?" It's gotten really boring at this point. Can you offer something other than "No, we can't!"? If you don't like Medicare, don't enroll in it. It's not mandatory. Go ahead and pay for your health care needs from your own pocket. But just because you don't like Medicare it doesn't mean others wouldn't like it either.

  144. As the humorist Art Buchwald once said , " The only thing keeping Canada's health care system alive is that we are between Mexico and them ." The only thing keeping Medicare alive is the presence of a private health care system paid for by insurance companies. Unless " Medicare -for -All " pays hospitals , doctors and other providers at private insurance rates , the argument supporting it is based on a false premise .

  145. @PFS Jr. Even if medicare for all paid providers at the exact same rate as private insurers do under today's system, the savings gained by operating under a larger economy of scale and the elimination of massive insurance company profits would still leave huge savings to the country as a whole.

  146. This is a bad analogy. States can't do it because of Interstate Insurance, the inability to tax or print money at the rate the federal government can.

  147. The experience of one state is hardly relevant. The tax base of Vermont is significantly smaller than the tax base of the United States as a whole. Further, a single state's employers would be disadvantaged compared to competitors from other states that would not have to pay for employee health care. Nor—contrary to the author's claim—do all the savings come from paying Medicare rates. They also come from eliminating marketing budgets, lobbying budgets, shareholder returns, hundred-million dollar executive compensation packages, corporate jets, and the need for every single medical practice to hire a full-time billing specialist to handle insurance companies. Also, contrary to the author's assertion, Sanders does make it clear how Medicare for All would be financed. But does it even matter? There was no financing mechanism for a trillion-dollar tax cut for the rich. The military budget isn't paid for by taxes, it's part of the deficit. Why suddenly get all sticky about how a social program is to be paid for but nothing else? I think we all know the answer to that!

  148. Why can't the USA implement a modern health-care-for-all program like the rest of the Western world? Every one of those countries had to start somewhere. Every one of those countries had obstacles to overcome. They still did it. Why can't Americans get their heads around it?

  149. @LauraF They don't want higher taxes and don't want to give up their present plans if they are any good.

  150. @LauraF Did you read the article? Paying for it is not as easy as you pretend.

  151. @LauraF Because money, that's why. Specifically the billions of dollars in profits that the for-profit health insurers and big pharma make by picking everyone's pockets and not providing them healthcare.

  152. We are evidently doomed to pay half again as much for our health care as other countries do. When our businesses pay for health care for some of us (their employees), we want them to do so by buying policies from health insurance companies rather than (as in other countries) by paying taxes or by raising our wages so we can pay the taxes. If businesses stopped buying health care for their employees (as some have), the money they saved would go for dividends, stock buybacks, or perhaps investment in the business. Do businesses that do not offer health coverage to their employees pay higher wages than similar businesses that do? Since health insurance costs thousands of dollars per employee, there should be a significant difference in wages and salaries. But there isnt. In a full-employment economy, businesses that did not provide health insurance would find it difficult to recruit or keep workers. So such businesses prefer an economy that booms enough to give them investment opportunities but not so much that their employees can easily find jobs with competitors that do offer health coverage. The bottom line is that we do not mind paying through the nose for our health care as long as the money goes into the private sector in complex and devious ways, but we hate paying for health care directly and obviously through taxes (except for Medicare). We seem to be confused, and billions are spent on advertising to keep us that way.

  153. Medicare For All could not get away with the relatively low reimbursement rates of existing Medicare. If the Federal government tried to exercise monopsony to control costs, providers would simply refuse to participate in Medicare and charge the market rate to those who could afford it. The rich would get medical care and everyone else would suffer. If laws were passed to force providers to accept Medicare payments, those laws would create a black market in medicine.

  154. I feel sorry for Americans. I truly do. As an expat living in Italy, I have posted many times here regarding the scam known as the U.S. health care system. You're all being fleeced by a system that's designed to pick your pocket rather than serve your needs. Even here in dysfunctional Italy, the health care system functions quite well and everyone can see a doctor without worrying about being shaken down by the doctors, hospitals, insurance companies and the myriad 3rd party vultures ready to collect on your bills. Why is it that European countries can offer health coverage at 1/2 the cost to their GDP's with outcomes that are arguably just as good or better than the States? I'll leave it up to you all to do some research and change your system, but I guarantee you this: if you keep listening to the "experts" about why a nationalized/single-payer/socialized system won't work, you're not listening to the right people.

  155. The bottom line is this: 1. Take away Insurers portion of expense, at least 10%, and take away deadbeats who don’t pay at ER now, and you have already 15-20% of savings, enough to offset the lower Medicare rates. 2. Add to that a small 2-3% tax on everyone, including young Americans, and a portion of higher taxes for the rich, and you may decrease the premiums or eliminate them. 3. Include preventive medicine practices and further savings will certainly show up 3-5 years down the road. We can’t do that in a single state because federal regulations will need to be enacted.

  156. Americans are not fit mentally to be healthy That is the greatest obstacle,it resides inside our brain like many things. Food and shows are our national disease.That is what the cost is all about On top of that the institution to manage health ,the state will cost for lack of competition Bear it

  157. By all means add a public option to the health care now offered by private insurance companies. If asked to choose between paying $1,000 more a year in payroll taxes to fund expanded Medicare or paying $14,000 a year in insurance premiums for a family of four, even the most devout Trumpie will opt for the public option. Same goes for employers who provide company-paid or company-shared health insurance for their employees. It's a no-brainer, which is why health care providers are fighting tooth and nail to prevent it.

  158. When it comes to endless wars, money is no object. Conversely, Medicare For All is cost-prohibitive to our bought and paid for politicians.

  159. The biggest challenge with implementing single-payer in the US is that we are going at it way too late. Other countries have enacted their single-payer systems decades ago, when healthcare costs were just 5%-7% of GDP and the transition to single-payer was still manageable. But healthcare costs in the US have now grown to 18% of GDP (while other countries have kept their costs under 12% thanks to better management, like single-payer systems). At this point, it may be that the best we can do is start with a public option, and do a slow transition to single-payer over 5-10 years.

  160. A first start failed. So what? But if you have 49 other stakeholders, and a dedicated team assembled, success has a greater likelihood. Thomas Edison would have never invented a light bulb with a failure oriented attitude. It’s not like a Moon mission where you get one shot to get it right. Did the rest of Western Democracy fail? No. Sheesh!

  161. Any time you see an "argument" from an editor of Reason, skip the lying words they type and comprehend their true agenda: Reason is run by anarcho-libertarians who believe the government should be replaced by powerful corporations and billionaires, who will rule vast fiefdoms as they please. This, to them, is the only ethical form of society. Yes, they are that radical.

  162. This is quite a leap. Because single payer failed in Vermont, it cannot work anywhere, ever? Many first world nations seemed to have done it. Also, this is a diversion. What the Right come out and say is: Only people who can afford health care should have access. When you oppose expanding coverage, your only resort is to create a straw man to shoot down. If single payer won't work, what are the GOP plans to ensure that our citizens won't die due to lack of coverage?

  163. It is disingenuous, truly deceptive to compare a small state’s attempt to have a single payer system to that of a wealthy nation’s. Medicare is not perfect, but close. As a recipient, I wish it for all.

  164. Single payer will work for the US just as it works well for most other modern countries who already have it and have much lower health care costs and much healthier citizens. Why does Suderman fail to see this? His analysis starts with an erroneous conclusion and then he picks an unrepresentative case which he mis analyzes to support his faulty premise. Bad logic. Bad analysis. Failure to look at all the data. You are wrong Mr Suderman. Single payer done correctly is just what the US needs.

  165. Well, Medicare works. TriCare works for 9.5 million people and counting. Why wouldn't these programs work for the rest of us? I've never heard any senior or military veteran/spouse complain about his/her health insurance. Let it be optional. Fools who want to pay the markup on private insurance can have at it. The rest of us can be covered, for a reasonable premium, and not be shackled to jobs we hate or (I know of several such cases) spouses we aren't crazy about any longer, just to keep health insurance.

  166. Yet every other major industrialized country on earth has chosen to provide their citizens with some form of national or single payer system. We must be so much smarter than all of them. After all, how else could we have the advantage of thousands of families going bankrupt each year due to their catastrophic medical bills.

  167. Republicans and Libertarians love to tell us a single payer doesn't and won't work and yet most of the countries in the industrialized world show us it can. I'm tired of these lame excuses for not enacting a national health plan, these same arguments we have heard repeatedly and they are just designed to protect the private insurance companies, medical equipment companies and big pharma. So stop telling us that it wont work Mr. Suderman, we look all over the world and see that it can.

  168. A single state system will always run into funding shortfalls as states do not collect as much revenue as the federal government. It is only with the federal tax base that universal health care will work. It is too bad our federal tax dollars go overwhelmingly towards military expenditures.

  169. Actually states have the power to raise taxes to pay for this program. From what I’ve read, Single Payer is supposed to save money and not cost more. If it costs more, then why change to it? As far as the Federal budget goes, most of the money is spent for Social Security, Medicare, Medicaid, Human Services, and Education. If we spent zero dollars on the military, we would still run a deficit each year. Please tell us where you would make the needed cuts in Social Security or Medicaid so that all liberals can rally around the idea.

  170. Single payer is the ultimate goal---the dream---but the current reality in the U.S. makes a quick leap into that future an untenable one. Even with broad popular support and a clear understanding among voters that while, yes, taxes will rise even as their overall household balance sheet is better off due to lower premiums and out-of-pocket expenses, it's impossible to disentangle overnight (or in a single term) a for-profit health care payment and provider apparatus that employs millions of people and through which HUNDREDS of billions of dollars flow each year. It's so easy to shout "Medicare for all! Single payer now!" but fervor and the righteousness of the goal are not a pathway to get there. The Vermont experiment needs to be taken seriously, not dismissed because "Well, other countries can do it so why can't we?!" Those other countries set up their systems a generation or two ago before health insurance of any kind was the norm (i.e. you paid your doctor or you didn't go). They were building payer systems where not much existed whereas the U.S. has a MASSIVE, lucrative and complex payer system already in place that must be reckoned with realistically.

  171. Without even looking at the legislation, let me guess, it was a compromise where conditions were set by the Republican side to introduce free market ideas into it. In other words, they injected the “ideas” they espouse when wanting to sound like they have ideas or principles. And it ruined it just like ACHA.

  172. Isn't this the same opinion page that just printed a piece showing that $200 billion is wasted every year on paperwork because of insurance form dupllicaiton? And if we had a much more equitable tax system in which the higher brackets, especially the upper 10% and 1% paid their fair share would provide a much needed supply of cash for medical care much more would be covered. Also we need a national, federally funded system, not a piecemeal state by state system.

  173. In my view the liberal position should be "quality healthcare for everyone". Saying that the program should be called "Medicare" or should even be a single payer program is something else that should be left for accountants and business experts not politicians. I suspect that a successful transition will eventually end in a single payer system, but the word TRANSITION is a big one and it may take a decade or more before we end up there. Changing how a huge fraction of the gross national product gets distributed will take time.

  174. It is not the matter of costs of Medicare For All. The saving are obvious. After it was implemented Americans would be shocked how much they were conned by insurers and for profit hospitals. And there is the threat, too much money against the reform, and too easy to demagogue the reform. Half of Americans would be screaming that they want the con to continue.

  175. This is an exceptionally mendacious article -- I wouldn't be surprised if Mr. Suderman does hack-work for the insurance or pharmaceutical industries. The Vermont effort was an experiment, and its failures/successes have been well-reviewed in medical and political magazines. Mr. Suderman cherry-picks the negatives while ignoring the positives. His greatest deception is asserting "it will never work" when nation-wide-single-payer in many varieties (as well as regulated insurance systems like Obamacare) successfully pay medical bills every day in countries all over the world. It's one thing to say "this will never succeed" and another to say "we cannot make this succeed". The former is false by virtue of the successes elsewhere. The later is true for now, perhaps, but that can change as the US pays more and more for less health and declining longevity. Every medical bankruptcy is a another argument for nation-wide health insurance of one sort or another.

  176. I support single-payer in concept. The challenge with your argument is that, for the most part, other countries had a clear(er) field upon which to implement such a system and not a network of firmly entrenched plans and other players willing to sabotage changes. And Western European countries have a much stronger sense of social solidarity generating support for single-payer. Think optimistically but don’t minimize the practical and scaling-up difficulties of MfA in our current world.

  177. Meh - I don't buy the argument that Americans are too incompetent to do what Germany, Sweden, Japan, France, Australia, Canada, Belgium, South Korea and other OECD countries have done. If you look at per capita spending on healthcare, the US matches or exceeds all but a two or three countries in public spending alone. In other words, US taxpayers are already fully paying for a decent single payer system. We just aren't getting our money's worth. On top of that, American private spending equals our public spending. If done as efficiently as, say, Germany, the savings on healthcare spending would be about $1 trillion. That is why Mercedes and VW can be more competitive than Ford or GM. They don't have huge healthcare bills to pay for their employees. Finally, forget about the myth that a public system precludes private supplemental insurance, if you want it. We don't need to reinvent the wheel. We can look and best practices in other countries, and also learn from their mistakes.

  178. Too many Americans resent paying any fees for medical care until they need it.

  179. It failed not because it is a bad idea or infaisable, but because conservatives say it is socialism.

  180. Sorry I don't buy this argument, to trash something that is universally beneficial and sound for our fellow countryman. If we want to make it work, we can. We have the resources. Tragic that the author and far too many others, will go to whatever lengths necessary to say universal healthcare, true universal healthcare can't work. It can if we want it too. Sickening that a profit system is what so many in this country want to see govern our lives, and the care of our bodies and health.

  181. People ask how we are going to pay for Medicare for all. We already are paying for it. We just aren’t getting it. We spend around $10,000 per capita on healthcare. The other first world countries spend $4,500 to $5,500 per capita. They get universal healthcare. We have parts of the US with infant mortality rates of a second world country. All the money we spend with private insurance would be redirected to Medicare for all. And we would save money.

  182. @Independent I'm in. "All the money we spend with private insurance would be redirected to Medicare for all." So, how do we get the private insurance industry (and their lobby) to just roll over? Seriously, though, that issue needs to be part of the solution. I don't think supplemental insurance plans would make up for the difference for that industry. I'm not advocating for or against them - but to be honest, that voice will be heard also.

  183. READERS TAKE NOTE: "Reason Foundation advances a free society by developing, applying, and promoting libertarian principles, including individual liberty, free markets, and the rule of law." This is taken from Reason's website, the advocacy group the author works for. It's the opening line of "About". Plain and simple propaganda still pushing the "free market" agenda, which is how we got here in the first place.

  184. So there are people who failed at it, therefore it is impossible. That is the "Party of NO" thinking out loud!