Medicare for All? First, some big questions

The Observer editorial board

Sen. Bernie Sanders unveils his Medicare for All plan for health care reform Wednesday in Washington.
Sen. Bernie Sanders unveils his Medicare for All plan for health care reform Wednesday in Washington. AP

The United States has long needed a real debate about the possibility of the kind of universal healthcare system that has led to some better outcomes in other developed countries. Sen. Bernie Sanders effectively kicked off that debate Wednesday by revealing a “Medicare for All” plan, backed by 15 Democratic Senate colleagues.

But even if you love the idea of all Americans having real health coverage (and we certainly like that concept in principle), it’s far too early to break out the champagne. As of yet, we don’t have enough details to know if or how much Sanders’s idea would improve upon the Affordable Care Act, which has lowered the uninsured rate to an all-time-low, saved thousands of lives and made it easier for millions of Americans to pay healthcare costs.

We do know that Sanders’ plan offers far more generous benefits – such as dental coverage and no out-of-pocket expenses for doctor visits – than single-payer plans in other countries. That begs a very big question: How would we pay for it? Talk of prescription drugs, surgeries and everything in between being covered, without requiring even a co-pay, can be intoxicating. But the Sanders plan doesn’t contend with the most difficult detail, and it lamely calls for a separate bill to deal with the financial and tax implications.

“The truth is, embarrassingly, that on this enormously important issue, there has not been the kind of research and study that we need,” Sanders wrote in the Washington Post. “You’ve got think tanks, in many cases funded by the drug companies and the insurance companies, telling us how terribly expensive it’s going to be. We have economists looking at it who are coming up with different numbers.”

That’s not good enough. There are lessons to be learned from the failed attempts at universal coverage in the liberal bastions of California and Sanders’s home state, Vermont, where officials dedicated to such reform could not devise a program that could be paid for without raising taxes to an unsustainable level, or at least one that wouldn’t cause most Americans heartburn. Additionally, an always-skeptical public must be convinced that such a system wouldn’t dampen medical innovation or result in a drop in the availability of care, as has happened in other single-payer countries.

Let’s be clear: Sanders’ plan has no chance of passing a Republican Congress. Introducing the bill Wednesday was about political positioning, for both Sanders and other Democrats.

But if we could build the American health care system from scratch – and not have to worry about dismantling the employer-based system that Americans have a love-hate relationship with – a single-payer plan would be easier to implement. The question is whether it can plausibly replace, and improve upon, what we currently have.

Sanders’s plan does not come close to providing an answer. But it’s not a bad place to start the conversation.