COMMENTARY: ‘Single payer’ must be considered skeptically
On Sept. 13, Sen. Bernie Sanders (I-Vt.) laid out the details of his new bill: The “Medicare for All Act of 2017.” The proposal already has 16 co-sponsors, and it has undoubtedly galvanized his constituency. Of course, when I say “constituency,” I mean his younger constituency. While Sanders’s plan may seem attractive to my fellow college students — who fear debt and the daunting prospects of finding a suitable career — they need to come to terms with the fact that single-payer is, at best, impractical and, at worst, in violation of basic American principles.
Sanders' plan is very bold: It would basically get rid of the employer-employee relationship (i.e. the government would be the “single-payer”), scrap most co-payments, extend benefits to those already on Medicare, and then extend those benefits to all Americans — all within a four-year period. Benefits would include everything from general care and emergency visits, to eye and dental care. An issue immediately presents itself: Medicare is already experiencing significant financial issues with its annual cost of about $700 billion. According to its program administrators, Medicare will soon experience “substantial financial shortfall.” Before moving on to a complete single-payer system, shouldn’t legislatures be focused on fixing the issues with healthcare at hand?
Some may argue that Sanders’s plan will solve the problem of revenue shortage with tax hikes. But the text of the bill isn’t clear about who these tax hikes will affect. It is only in a separate document that some “potential options” for funding were named, and even so, these “potential” funds would only amount to about $16 trillion. This will prove to be a challenge considering that the total price tag of Sander's plan would amount to $32 trillion within its first 10 years of operation — at least, according to the left-leaning Urban Institute.
This isn’t all hypothetical speculation. Single-payer failed in Sanders’s home state of Vermont. “It is not the right time,” said Gov. Peter Shumlin (D-Vt.), who went on to note that its effects on individual incomes “might hurt our economy.” Richard Gottfried, a New York assemblyman, called the failure in Vermont only a “small speed bump” even though his attempts to push for single-payer in New York have consistently failed since the early 1990s due to practical concerns.
Some point out that single-payer works in countries such as Canada, the Netherlands and Australia. But if you’re pushing a healthcare plan that parallels their own, don’t look to Sanders — the benefits in his proposal are much broader than those of other nations. For instance, two-thirds of Canadians need to take out private insurance plans since their policies don’t cover vision, dental care, prescriptions, rehabilitative services or home health services — Sanders's plan covers all these. The fact that the United States is much larger than European countries — think Sweden and Norway — and less homogeneous, is also something to consider before attempting to apply their systems to ours.
Sanders's single-payer plan isn't only flawed on a practical level. A look at Sanders’s recently published Op-Ed in The New York Times brings some basic moral considerations to the forefront. In the beginning of his article, he questions when Americans will view healthcare as a “human right.” But is healthcare really a “right?” When it comes to the United States, the founding fathers intended on creating a society built around negative rights—what the government, and other aggressors, could not do to coerce the people. Consider the Bill of Rights: There is no mention of any positive rights, in other words, there is no mention of a right that requires the government to provide resources to the people — at least on a federal level.
Sanders mentions the issue of the 28 million people who are uninsured. Even if one was to cede that this was terrible, what does Sanders have to say about another fundamental human right: the right of choice? Considering that he believes health care to be a human right, will he also condemn the Affordable Care Act's “individual mandate” that essentially forces Americans to buy a product?
Sanders goes on to cite an Economist/YouGov poll, which notes that 60 percent of Americans want to “expand Medicare to provide health insurance to every American.” First of all, considering the variety of polling data on the issue, and the way that polling questions are framed, it isn’t truly clear what Americans want out of healthcare. Regardless, has Sanders forgotten about Montesquieu's separation of powers? About the founders’ rejection of “mob rule?” One can disregard the founder’s skeptical approach to pure democracy — most effectively outlined in James Madison’s Federalist No. 10 but they would also be disregarding a tradition that stems from Aristotle himself: the idea that nobody — not even the tyrant called the “majority”—has the ability to oppress and coerce the minority.
I am not saying that Sanders is an evil man, nor am I saying that all government assistance is wrong or unnecessary. You may notice that I didn’t even provide an alternative — after all, I can’t say I have all the answers. What I am saying is that us impressionable students need to take a step back and consider the practical — and ethical — ramifications of single-payer healthcare before coming to black and white conclusions.
Jacob Yaakov Miller is a School of Arts and Sciences first-year majoring in political science.
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