By Jane M. Orient, M.D., of the Association of American Physicians and Surgeons
There is one thing that supporters and detractors of Bernie Sanders might agree on: He seems to be honest about his convictions. He is an avowed socialist, instead of pretending to believe in a role for private insurance. Unlike Barack Obama, his answer to the question "Do you get to keep your insurance plan?" is plainly no. There won't be any more insurance plans. Everyone will be on Medicare.
Other questions are tougher. Do you get to keep your doctor? That depends on what you mean by your doctor. You might be seeing the same person, in the same office. But he won't be paid by you, and under Medicare "alternative" payment methodologies, he won't be paid for what he does for you. He might, in fact, be paid for not doing things for you, to meet the savings goals of the New Generation Accountable Care Organization (affectionately known as New Gen ACO) in which you will be automatically enrolled.
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You shouldn't judge a politician by his looks, but people often do. Sanders looks like Grandpa – kind and benign. The face of Medicare, however, is Acting CMS Administrator Andy Slavitt. If you were Central Casting, you would probably cast him in a role like the one he has had in real life: a Goldman Sachs banker and CEO for a UnitedHealth Group subsidiary. Such people get their positions through ruthless dedication to the corporate bottom line. What does Sanders think of him?
Medicare is today's single payer for the elderly and disabled. All the money is funneled through government, though it is first taken from hundreds of millions of taxpayers and disbursed through private contractors called carriers. Would Sanders replace that with a purely governmental entity like the VA, the single payer for veterans? In the VA, it is government bureaucrats who delay and deny care instead of corporate bureaucrats.
Veterans can go outside the system if they like, and pay privately. Medicare beneficiaries cannot, unless they see a physician who is opted out or disenrolled or excluded. What does Sanders plan to do about your liberty to use your own property to pay for goods or services to enhance or extend your own life? Doesn't he, like Hillary Clinton, plan to "take things away from you, for your own good"? And does that include, like in Canada, your right to private care? It sounds as though it does. The additional $28 trillion in federal spending for his plan is supposed to replace insurance premiums and out-of-pocket payment. With the Sanders tax increases, the money available for discretionary spending will be much less, but if you do have any savings, would you be allowed to spend it on medical care? Or would that be unfair to the people waiting in long lines?
And there's the $28 trillion question for Sanders: Where does the money come from? Even if we could squeeze every last dollar out of billionaires and transform all their wealth into medical care for the masses, we don't have 28,000 billionaires – or 28,000,000 millionaires.
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And what will Sanders do about the more-than-$40 trillion in promises Medicare has already made without provision for the revenue to pay for them? What does he imagine will happen when he adds on the demands of the entire rest of the population, and removes any brakes on utilization like copays and deductibles?
Incremental socialism is already bringing the system to the point of collapse. Hawaii is proposing a response to the fact that 30 percent of physicians are already refusing to work under Medicare: forcing physicians to accept Medicare patients or lose their license. Will Sanders try to conscript physicians?
What will he do about the worsening shortages of essential drugs? One hospital reportedly told physicians there would be no morphine until the end of March. Will Sanders nationalize the pharmaceutical industry? Would that help, or make things worse?
Insurance is voluntary. Socialism is force. How much force will Sanders use to take what remains of your doctors' liberty – and yours? He needs to tell us that, as well what he intends to use to pay for it.