In 2017, the United States spent $3.5 trillion in taxpayer dollars on health expenditures to keep Americans alive and healthy. Yet, even though we spend twice as much on healthcare as other developed nations, 27.5 million Americans were uninsured in 2018. As a result, Bernie Sanders’ 2020 campaign has centered around a socialized healthcare plan – Medicare for All. If America is to overcome its healthcare crisis, we must ask if Sanders’ plan is justified both in principle and in practice.
Socialized healthcare is justified in principle for two reasons. First, an overwhelming majority of Americans support the policy. The Reuters News Agency reports that 70 percent of Americans – including 50 percent of Republicans – back a single-payer system. Thus, Medicare for All should be implemented because it is popular and politicians have an obligation to represent their constituents.
Opponents will point out that the American public is not well-informed and that Medicare for All’s support will drop once people have been educated. A Kaiser Foundation poll shows that while 67 percent of Americans back Medicare for All when told the plan would eliminate premiums, that support fell to 26 and 37 percent with a conservative framing of the plan. However, a YouGov study found that while conservative framing for Medicare for All results in about 38 percent of people favoring the program, progressive rebuttals bolster support to 52 percent, compared to 51 percent support with no framing. Therefore, educating the American public from both perspectives has a negligible impact on its perception of socialized health care.
The second reason a single-payer system is desirable in principle is because in the status quo, millions are uninsured, and thousands die as a result. The American Journal of Public Health estimates that up to 45,000 die each year because they cannot access insurance, and Medicare for All would ensure that they have access to health care, meaning the country’s overall welfare will improve. While critics may say the price will balloon due to more people seeking healthcare, additional costs can be offset with new tax revenue, and I would argue that fewer people dying is always good for the country.
Medicare for All’s biggest criticism is the cost. Most opponents claim that the initiative is too expensive and Sanders does not have the means to pay for the expenditure. Funding concerns, however, are easily addressed in two ways. First, most of the money needed to finance a single-payer program already exists in the current system. A study from the Mercatus Center estimates Americans will save $2 trillion over ten years, and while the author and the Washington Post have said this detail is cherry-picked, alternative analysis suggests that the research overestimates the cost for Medicare for All. Steffie Woolhandler and David Himmelstein, professors of Public Health at the City University of New York at Hunter College, along with Dr. Adam Gaffney, argue that socialized health care would save $500 billion annually on administrative costs, negotiate drug prices to save more than $61 billion. Local and state governments would save $3.6 and $5.3 trillion on employee benefits and health programs, respectively.
The opposition also claims that taxes on the middle class will rise. However, any new taxes raised would replace – not compound – the $10 trillion businesses pay for premiums, the $7.7 trillion individuals pay on premiums and $6.3 trillion out-of-pocket expenses. For example, Sanders’ proposed taxes would raise about $13 trillion, according to the Citizens for Tax Justice, and economists Emmanuel Saez and Gabriel Zucman predict Sanders’ wealth tax will raise $4.35 trillion over a decade. Finally, Sanders’ has advocated for reversing the 2017 tax cuts to pay for socialized health care. By the CRFB’s estimate, the cuts will reduce tax revenue by $1.9 trillion over ten years, so reversing these cuts can help pay for a single-payer system. As a result, even if taxes increase, the average American will save $6,000 over a decade, meaning Sanders’ plan is economically superior to the status quo.
Medicare for All would be a radical change from the status quo, but socialized healthcare is ultimately the best system for Americans. Businesses would save by paying payroll taxes instead of premiums, the everyday American would save thousands by paying higher taxes instead of premiums, copays or out-of-pocket expenses, and the U.S. would spend less on healthcare while achieving greater outcomes. Really, the big question that Americans should be asking is why we haven’t already switched to a single-payer system.