END OF 2018 OPEN ENROLLMENT PERIOD (41 states)

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Sanders's plan may cost $14 trillion or $32 trillion, but either way it sure as hell WOULD be "disruptive"

Just yesterday, the Urban Institute released a detailed analysis of Bernie Sanders's "Medicare for All" plan, which would actually be far more comprehensive than Medicare is, not just in terms of how many Americans it would cover (everyone!) and what percentage of costs it would cover (everything!) but also in terms of what ailments/services it would cover (all of them!).

Their conclusion was that such a policy would cost over twice as much as Senator Sanders claims (around $32 trillion over the next decade on top of what the federal & state governments currently spend, versus the $13.8 trillion that Sanders estimates). Their conclusion was even more expensive than the $24 trillion estimate from a prior analysis by Kenneth Thorpe (the guy who put together Vermont's failed single payer proposal a decade ago).

Of course, there was major pushback of both reports from the Sanders camp; in particular, David Himmelstein and Steffie Woolhandler, both of whom are co-founders of Physicians for a National Health Program, immediately wrote up a response piece which blasts the Urban Institute estimates as including "ridiculous assumptions". Appropriately, Himmelstein and Woolhandler also wrote a similar rebuttal to Kenneth Thorpe's analysis back in January.

For instance, currently, overall administrative overhead apparently runs at around 9.5% of total costs. The Urban Institute assumes Bernie's plan would run around 6.0% thanks to increased efficiency, less red tape and so forth, using overall Medicare overhead as a guide. Thorpe assumed around 4.7%. Himmelstein/Woolhandler assume it would only run around 2.0%, since overall Medicare includes privately managed Medicare, which would be eliminated, and since Canada supposedly only has a 1.8% administrative overhead.

Now, a lot of the number crunching on both sides goes way beyond my pay grade. I have no idea whether 6% or 2% is more "realistic" or "ridiculous". My guess is that the actual overhead of such a plan would probably fall somewhere in between, at least for the first few years (perhaps around 4%).

I'm not going to rip on some of their other critiques, as I really don't know which analysis is more or less realistic for most of them. I am, however, going to take issue with their final bullet point:

5. Holahan’s argument that the Sanders plan would cause a huge disruption of health care: This argument mirrors scare tactics used by Medicare’s opponents in 1963. Back then, there were claims that doctors would boycott Medicare, and Wall Street Journal headlines warned of a “Patient Pileup,” as “flocks of Medicare beneficiaries ... suddenly clog the nation’s 7,200 hospitals.” Nothing like that ever happened, nor did it happen when Taiwan implemented single payer more recently. And there’s no reason to think it would happen here.

Moreover, surveys show that most doctors would welcome national health insurance, and thousands of doctors have recently issued a call (and detailed proposal) for single-payer reform in the American Journal of Public Health.

Doctors boycotting it? Maybe not. patient pileup? Maybe not.

However, to try and claim that it wouldn't be a "huge disruption of healthcare" is absurd. Of course it would be hugely disruptive; "disrupting the system" is exactly the point. If Senator Sanders didn't want to "hugely disrupt" the current healthcare system, he'd be supporting the "incremental improvement" approach favored by Hillary Clinton, including ideas like allowing those under 65 to buy into Medicare.

Instead, his response to this idea today was this:

Secretary Clinton’s proposal to let the American people buy into Medicare is a step in the right direction, but just like her support for a $12 minimum wage, it is not good enough,” Bernie Sanders says in statement to Bloomberg Politics.

Not good enough? Medicare, according to just about all progressive parties, is the gold standard. Bernie's own single payer plan is even called "Medicare for All" (even though it isn't really Medicare). Yet allowing people to buy into it "isn't good enough". He wants to require Medicare coverage (actually, far more than Medicare) for everyone, with the only exceptions apparently being the VA and the Indian Health Service (according to the Urban Institute report).

Whether you agree with his plan or not, to try and argue that it "wouldn't be hugely disruptive" is just silly.

Again, as I said back in January (and as the Urban Institute concurred yesterday):

Remember the several million people whose pre-ACA policies were cancelled back in December 2013 for not being compliant with the new law? Remember the backlash to those several million having their policies taken away after the "if you like your plan you can keep it" brouhaha? Even though the vast majority of them ended up replacing their old policies with new ones which, for the most part, have better coverage (not to mention protection from being dropped via rescission, denial for having a pre-existing condition, maximum caps on their out of pocket expenses and, for many people, lower premiums thanks to financial assistance), the fact remains that when it comes to healthcare coverage, most people take it very personally.

That was only a few million people (plus a few million more since 2013 due to the 3-year "transitional period" extension granted in response to the backlash.

Now imagine not a few million, but 300 million* people having their policies shut down and replaced with a new one all at once. Imagine the anger, the chaos, the confusion...even if the new system turns out to be better, more efficient, less expensive and less confusing across the board.

*(Seeing how there's over 50 million people enrolled in Medicare (by the current definition) already, the Urban Insititute gives the number directly impacted as more like 272 million. However, there'd be significant changes to the coverage of those 50 million as well).

THIS has been my biggest concern about Sen. Sanders's plan all along. Not the budget or costs involved (although those are obviously very important), but the ripple effect on every other facet of the U.S. economy, along with the logistics of making such a large change over such a short period of time. Even positive effects can cause very ugly things to happen in the short term, and those factors have to be taken into account.

Universal, comprehensive, efficient coverage is a worthy long-term goal, whether via single payer or some hybrid model...but expecting it to happen over the course of a few years is simply not realistic in my view when doing so would upset so many apple carts (and not just of fat cat CEOs).