Sen. Bernie Sanders

In 2017, Canadians were on waiting lists for an estimated 1,040,791 total procedures. Often, wait times are lengthy. For example, the median wait time for arthroplastic surgery (hip, knee, ankle, shoulder) ranges from 20 weeks to 52 weeks. In the British National Health Service, cancelations are common. Last year, the National Health Service canceled 84,827 elective operations in England for nonclinical reasons on the day the patient was due to arrive. The same year, it canceled 4,076 urgent operations in England, including 154 urgent operations canceled two or more times. Times of high illness are a key driver in this problem. For instance, in flu season, the National Health Service canceled 50,000 “non-urgent” surgeries. In Canada, private insurance is outlawed (as it would be under Sanders’ proposal). In 2017, “an estimated 63,459 Canadians received non-emergency medical treatment outside Canada.” In Britain, private insurance is permitted—but it is an additional cost to the taxes that British citizens pay for the National Health Service. Escaping the system is an option for the wealthy, or for those who are willing to forego other expenditures to get the care they want or need.

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The tax burden would be enormous, roughly doubling the current tax obligations for today’s taxpayers. One funding option Sanders proposes is a 7.5 percent payroll tax, plus a 4 percent income tax on all Americans, as well as a wide variety of specialized taxes on investments and taxes targeted to higher-income Americans.

Under the Sanders proposal, for example, cost control is secured by a global budget and by imposing Medicare payment rates. Blahous, a former Medicare trustee, estimates that under the Sanders proposal, provider payments would be cut by an estimated 40 percent by usingMedicare payment rates. Using Medicare payment rates throughout the entire American health care economy would hurt patients. Already, the Centers for Medicare and Medicaid Services projects that “nearly half of hospitals, approximately two-thirds of skilled nursing facilities (SNFs), and over 8 percent of home health agencies (HHAs) would have negative total facility margins.”

The Urban Institute estimates 10-year spending of $32 trillion, only about half of which would be covered under Sanders’ funding options Mercatus Center’s Charles Blahous estimates a 10-year $32.6 trillion increase in federal spending. Even “doubling all currently projected federal individual and corporate income tax collections would be insufficient to finance the added federal costs of the plan.” Economist Kenneth Thorpe of Emory University estimates $24.7 trillion in additional federal spending, and also estimates an average deficit of $1.1 trillion per year. The Center for Health and Economy estimates a 10-year net cost of up to $44 trillion, and an annual deficit of $2.1 trillion.

The cost of a single-payer system would depend upon its design, benefit levels, and scope of coverage.

His planwould finance the national insurance program through a combination of payroll and income taxes, and it would replace private and employer-sponsored health insurance and existing government health programs—including Medicare itself.

A “single-payer” health system is a government-controlled health care system. Government is the “single-payer.” In most versions of single-payer, most private health insurance is either outlawed or restricted, and most public health programs are absorbed into the single, national health insurance program.

What Is Single-Payer?