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On the Third Hand: Berniecare

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If reading the name “Bernie Sanders” could damage your health, please look away. Only you know what your system can take.

Assuming you’re still here: I think the obvious lesson of Sanders’ effort to introduce his single-payer health care proposal is that, no matter how well a single-payer health care system could, theoretically, work, according to advocates of that approach, no president will be able to make such a system work well in the United States any time soon.

On the one hand, many readers are fervent advocates for the purest possible free-market health care programs for ethical reasons, and many others favor a less-is-more approach to government involvement because they think markets tend to work a lot better than government bureaucracies.

See also: Doctors’ strike suspended in England amid progress in talks

On the other hand, some readers like the idea of a government-run universal health care system, at least in theory, and there’s no obvious fundamental law of the universe that requires a reader to oppose that kind of health care system.

Many readers make a good living selling Medicare supplement, Medicare prescription drug and Medicare Advantage products. Medicare is, in effect, a government-run universal health care program for U.S. residents ages 65 and over.

Some readers sell individual or group disability insurance. In the United States, private disability insurance is really a product that supplements a quasi-universal Social Security Disability Insurance (SSDI) program.

Medicare and SSDI have many obvious problems, but a high percentage of readers have learned to live with them. Few readers are sending us angry letters about the mere existence of Medicare or SSDI.

On the third hand, for purposes of writing this column: I try to be as non-partisan as I can be. I try to look at the Patient Protection and Affordable Care Act (PPACA) and other health system change efforts from the perspective of someone who just wants whatever systems that happen to exist to work as well as they can, under the circumstances, and to teach us as much as they can, under the circumstances.

And I think what Sanders’ campaign team is saying, through its actions, is that even candidates who are trying to run for president as angry outsider populists are just too chicken and too mealy-mouthed to be straight with us about health policy.

The major Republican PPACA repeal and alternative proposals have been pretty disappointing.

If a Republican candidate wants to channel Ayn Rand and say, “We’re going to do away with all government health care programs, and improve health savings accounts (HSAs), and, the truth is, some new gaps in health care access might crop up,” that candidate can get away with putting out a 10-page health care policy proposal that amounts to, “Let’s replace the current system with better HSAs.”

But, if a Republican candidate wants to keep many PPACA mandates, get rid of the PPACA tax penalties on individuals who fail to buy health coverage and on employers that fail to offer coverage, and tells me that coverage prices and coverage access will stay about the same: That candidate has to do more for me than promise to improve the HSA program. That candidate has to explain why cutting PPACA tax penalty broccoli out of my diet won’t give me malnutrition.

Meanwhile, if a Democrat wants to tell me, in the wake of the transparency problems the PPACA exchange system has had, “We’re going to have the government take over all allocation of health care services, with help from spending increase caps, and some advisory councils that include a lot of consumers,” that Democrat has to demonstrate the ability to be brutally honest and give me bad news straight. That Democrat (or: independent, or democratic socialist running as a Democrat) has to show me that he or she is quick to recognize and retract unrealistic promises.

So, what does Sanders do? 

He dithered about preparing a campaign-friendly Medicare-for-all proposal for months, then finally terrified campaign reporters by releasing a shockingly, shockingly! detailed proposal that takes up the equivalent of about seven double-spaced typed pages!

The actual mechanics of his proposal takes up an enormous 363 words, or about one-and-a-half double-spaced typed pages! The horror, the horror…

In other words, his proposal is so lacking in detail he could have just said, “Hey, I’m really, really socialist,” and that would have been only a little more vague than the proposal he actually put out.

He has given somewhat more detailed versions of his proposal in bills he has introduced. He suggests in the single-payer health care bill he introduced in December 2013, for example, that one of his main mechanisms for holding health care spending down would be to limit growth in spending to 3 percent more than growth in per-capita gross domestic product (GDP), and that another would be to make a state use its own money to pay for health care if its spending went over budget.

Elsewhere, Sanders says a state plan could cut reimbursement rates for providers every three months, if it was having health budget overrun problems. 

So, where are those ideas in the new Medicare-for-all proposal? I don’t see them.

Maybe because they sound scary.

Of course, if it’s possible to make a single-payer health care system work in the United States, some aspects of that system would be scary. We’d put up with new constraints in the hope of reducing health care and care administrative costs, and improving care for the poor and the sick.

But all Sanders dares to show us is the pure unicorns-and-rainbows version of his proposal, not even the hazy details he put in a shot-in-the-dark bill two years ago.

He has no more ability to tell his story to us straight than the U.S. Department of Health and Human Services (HHS) has had to tell us roughly how many employers have set up PPACA Small Business Health Options Program (SHOP) plans.

Through his actions, he’s supported the idea that the recent performance of HHS is the result of health policy being too hot for government administrators to handle, rather than a peculiar flaw in the communications strategies of Obama administration appointees.

If even Sanders gets the vapors when he tries to talk to voters about how Berniecare might work, then it’s hard to believe that his administration or any other could develop the spine to implement such a hot-potato program in an effective fashion any time soon. Even if he or some other future president managed to get the program up and running, we’d likely emerge with the rainbows and unicorns version enshrined in the law and regulations, worms and flies in the actual operations, and program managers who threw fits when anyone tried to tell them that their rainbows were worms.

See also:

LTCI Watch: Transparency

On the Third Hand: Venezuela


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