-Bernie Sanders is introducing his Medicare-for-All bill.
-I intend to cosponsor the Medicaid-for-All bill.
-Under the guise of Medicare-for-All.
-That's what Medicare-for-All is all about.
-Medicare-for-All is actually
much cheaper than the current system.
-It guarantees healthcare to all people
in a cost-effective way,
which is what Medicare-for-All is.
-Transitioning US healthcare from a private insurance system
to Medicare-for-All or a single-payer system
would be a massive endeavor.
After all, healthcare accounts for 1/6 of the US economy.
And right now, people get their plans from all over the place.
-It might be paid for by your employer.
You might buy your own insurance plan.
You might be on Medicare.
You might be on Medicaid.
Single-payer means that there's one payer, the US government,
and it would pay for everyone's healthcare bills.
-That's not cheap, and taxpayers are likely to foot the bill.
So, just how much would this all cost?
Well, that depends on who you ask.
-Let's just say hypothetically -- -Okay.
-You are self-employed
and you've got a husband and two kids, okay?
Family of four.
Do you know how much that family is paying today for healthcare?
-How much? -$28,000 a year.
-Okay. -But that $28,000
isn't as straightforward as Sanders makes it seem.
It comes from the Milliman Medical Index,
but that index is used for people who get insurance
through an employer, not those who are self-employed.
The Sanders campaign said he misspoke,
but he's previously tweeted the same factoid
without the self-employed qualifier.
Regardless, Sanders' language is misleading.
According to the index, almost $16,000 of that $28,000
is already covered by employers, so the visible cost
to the ordinary employed 4-person family
is a little over $12,000.
-Are people gonna pay more in taxes?
Yes. But at the end of the day,
the overwhelming majority of people
are gonna end up paying less for healthcare
because they're not paying premiums, co-payments,
and deductibles.
-In order for this family of four to feel
like they're saving money under a Medicare-for-All system,
their taxes would need to increase
by less than about $12,000 per year,
and that tax increase depends on a wide variety of factors.
Think of this like an equation.
As each of these numbers goes up or down,
the overall cost to taxpayers changes along with it.
1, of course, is how much you pay doctors and hospitals.
If the government pays them less than they're getting now
under commercial plans,
then, yes, you could achieve more savings.
However, a lot of people have argued that it's not feasible
to suddenly reduce payments for doctors and hospitals
to Medicare rates.
-Doctors and hospitals could argue
they can't provide adequate care
because they would no longer have the funds
to cover their costs.
But say, for example, hospitals were paid at current costs
and only doctors reduced their rates to Medicare levels.
With that assumption, one study found healthcare costs
would rise and national healthcare
spending would be higher than the current system.
Senator Sanders' plan includes coverage
for a loosely defined set of services
related to long-term care,
but they're careful to exclude nursing homes,
saying Medicaid could still pay those costs.
-If you add in long-term-care services,
people are saying that would add
significantly to the cost of the legislation
and make it a lot harder to fund.
And there's also the question of cost-sharing.
You know, employees are generally required
to contribute a monthly premium.
They often will face a deductible,
as much as $5,000, $10,000.
Under Sanders' plan, he would eliminate all of this.
People would be able to visit the doctor
without any extra cost.
-Analysts warn that could lead to rampant overuse
of the healthcare system.
-Medicare-for-All advocates frequently cite a figure
for the administrative costs for Medicare and say,
you know, that's significantly less than
what private insurance now pays.
But that's up to dispute,
and there are other experts that say that, actually,
the administrative-cost estimates for Medicare
are actually higher, so if they're wrong about that
and they're not able to get those efficiencies,
healthcare's gonna cost more.
-The Sanders campaign pointed to two studies,
one done by the University of Massachusetts
and one by the RAND Corporation, which show middle-class families
would save under a Medicare-for-All system.
But both studies make generous assumptions
about the government's ability to negotiate
lower payments to providers
and to slim administrative costs.
The thing is each one of these factors
has dramatic implications for the tax burden
of any Medicare-for-All plan,
and so without reliable estimates
or consensus among experts,
Sanders' assurance that the average family of four
would save somewhere between $12,000
and $28,000 is misleading at best.
It only comes to fruition under the best possible circumstances.
-Two of the biggest healthcare programs that have been enacted
in the past were Medicare and Medicaid.
And years later,
people discovered there were unintended consequences.
What single-payer is proposing to do with Medicare-for-All
is a much bigger scale than, say, for instance, Obamacare,
or the Affordable Care Act,
which was mostly focused on the individual market.
-The only certainty when you're making big changes
to the healthcare system is that it won't go as planned,
and so when a politician tells you that you're gonna save money
under a given plan, don't count on it.
Sanders is trying to paint his plan
in the best possible light,
and so he's using assumptions that will do that.
In other words, it could end up being a lot more expensive
than he's saying.
-You're not paying any more co-payments.
You're not paying any more deductibles.
How's that? $28,000 you're not paying.
But does that mean you're not gonna pay something?
Of course it does. You're gonna pay more in taxes.