May 8, 2019 | Updates

Separating Senator Sanders’s Rhetoric From Reality On ‘Medicare For All’


WASHINGTON – As his costly “Medicare for all” proposal continues to face serious criticism from independent analysts, high-profile editorial boards and leading Democrats, U.S. Senator Bernie Sanders (I-Vt.) penned an opinion piece forBuzzFeed in which he lashes out at the Partnership for America’s Health Care Future’s efforts to build and improve upon what is working rather than eliminate the foundations of American health care and start from scratch with a one-size-fits-all system run by the government.

The Partnership submitted the following response to BuzzFeed, whose editors chose not to publish it.  It is included in its entirety below.

Separating Senator Sanders’s Rhetoric From Reality On ‘Medicare For All’
By Lauren Crawford Shaver

When it comes to campaign promises, there’s rhetoric and there’s reality.  Rhetoric only goes so far, and sooner or later candidates have to answer for the real-world implications of the policies they support.

That’s why, as the growing body of research around Medicare for all continues to lay bare its unaffordable costs and the threats it poses to patients’ access and quality of care, key Democratic voices – including some 2020 presidential hopefuls – are expressing grave concerns about the negative impacts, both practical and political, of embracing a one-size-fits-all government-run health care system.

Americans, including many who had not previously paid close attention to Medicare for all, are beginning to ask questions – such as how much it would cost, how taxpayers would be forced to bear the burden of its massive price tag, how its drastic provider payment cuts could impact patients’ access to their doctors, increase wait times, reduce the quality of care they would receive and even threaten to force some hospitals to close their doors.

These are important questions.  Tellingly, they are also aspects of Medicare for all about which Senator Bernie Sanders (I-Vt.) and other supporters have been vague, preferring instead to rely on slogans, lofty rhetoric and divisive attacks on those who don’t fall in line – as Sanders does in an opinion piece published by BuzzFeed on May 2nd.

Thankfully, independent analysts are doing the hard work of cutting through the clutter and separating rhetoric from reality on Medicare for all.

The latest example is a report issued by the nonpartisan Congressional Budget Office (CBO), which brings the risks of a one-size-fits-all system into stark relief, warning that it “could cause substantial uncertainty for all participants,” and that its implementation “could be complicated, challenging, and potentially disruptive.”

Looking at costs, the CBO warns that Medicare for all “would significantly increase government spending and require substantial additional government resources,” also known as tax hikes on working families.

That is a point backed up again and again by independent analysts, who estimate the price tag for Medicare for all could be as high as $60 trillion over 10 years.  The nonpartisan Committee for a Responsible Federal Budget (CRFB) found that even a low-end estimate of $30 trillion “would mean increasing federal spending by about 60 percent (excluding interest)” and “require the equivalent of tripling payroll taxes or more than doubling all other taxes.”

“There’s no possible way to finance [Medicare for all] without big middle class tax increases,” CRFB’s Marc Goldwein recently explained.

The CBO also warns that under Medicare for all, “patients might face increased wait times and reduced access to care.”  The steep cuts Medicare for all makes to providers, the CBO finds, could cause a long-term shortage of health care professionals like doctors and nurses and “also reduce the quality of care.”

In a Medicare for all system, “[t]he number of hospitals and other health care facilities might also decline as a result of closures, and there might be less investment in new and existing facilities,” they write.  Again, the CBO’s findings are backed up by recent research casting light on the negative impacts Medicare for all would have on providers and patients throughout the country.

A recent study prepared by KNG Health Consulting for the American Hospital Association and the Federation of American Hospitals found that Medicare for all “would compound financial stresses [hospitals] are already facing, potentially impacting access to care and provider quality,” while another recent study, conducted by Navigant, found that Medicare for all could force hospitals to limit the care they provide and even “force the closure of essential hospitals.”

And under Senator Sanders’s Medicare for all system, Americans would have no choice – literally – but to suffer these consequences.  This is because the private coverage on which 217 million Americans currently depend – along with Medicare, Medicaid, the Children’s Health Insurance Program and the Affordable Care Act – would be outlawed.

The CBO puts it this way: “Because the public plan would provide a specified set of health care services to everyone eligible, participants would not have a choice of insurer or health benefits.  Compared with the options available under the current system, the benefits provided by the public plan might not address the needs of some people.”  They add that, “unlike a system with competing private insurers, the public plan might not be as quick to meet patients’ needs, such as covering new treatments.”

Sanders would claim he is doing Americans a favor by eliminating their current coverage and shifting health care choices away from doctors and patients to politicians and bureaucrats.  But in reality, public opinion research shows that a majority of Americans are satisfied with their coverage and care.

It’s no wonder that the more Americans learn about Medicare for all, the greater their opposition grows.  A national poll conducted by the Kaiser Family Foundation found that support plummets once Americans learn it would eliminate their existing coverage, lead to longer wait times and lower-quality care, and force families to pay higher taxes to cover its costs.

With roughly 90 percent of Americans now covered, there are far wiser, less disruptive and more affordable ways to expand access to affordable, quality health care.  And in fact, a constructive approach – one of “targeted actions” – is favored by most Americans, including majorities of Democrats and Democratic-leaning independents.

Rather than eliminating Medicaid, as Sanders would do, we should expand the program in states that have not yet done so, which would immediately cover millions of Americans.  We should also strengthen available federal subsidies so Americans of all income levels can choose market-based coverage that fits their needs.  And we should use proven tools like reinsurance to stabilize premiums and control health care costs.  These are just a few ideas that could have a substantial positive impact on families and patients throughout the nation.

More can and should be done to make health care work better for each and every American – but the way to get there is by building and improving upon all the progress we have made, not by tearing it down as Senator Sanders would have us do.

Lauren Crawford Shaver, the executive director of the Partnership for America’s Health Care Future, was previously the deputy assistant secretary for public affairs in health care at the U.S. Department of Health and Human Services and has worked on numerous Democratic political campaigns over the last decade.



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