All Aboard the Bernie-care Bandwagon?
On September 13, Sen. Bernie Sanders, backed by 16 Democratic co-sponsors—one third of the Democrats in the Senate—unveiled his “Medicare For All” bill. As Sanders said in one of his many interviews accompanying the rollout:
Right now, if we want to move away from a dysfunctional, wasteful, bureaucratic system into a rational health-care system that guarantees coverage to everyone in a cost-effective way, the only way to do it is Medicare for All.
We might pause over Sanders’ damning commentary on the current healthcare system, as seen in his choice of words: “dysfunctional, wasteful, bureaucratic.” Those words are, of course, damning of the man substantially responsible for the healthcare status quo, namely, Barack Obama. Of course, Sanders never pretended to be a big fan of the 44th president.
These days, the left has, in fact, moved on from Obama; progressives who once loved Obamacare are now even more in love with “Sanderscare.” The headline-writers at The Washington Post, for instance, couldn’t hide their enthusiasm: “Sanders introduces bill that would revolutionize U.S. health care. And he has a record level of support.”
Speaking of support, Sanders believes that he has the wind at his back. As he wrote in The New York Times on Wednesday, 60 percent of Americans support “Medicare for All,” or, as it might more properly be called, single-payer insurance. (Or, of course, we could call it Berniecare.)
Without a doubt, as the Republicans discovered this year as they failed in their repeal-and-sort-of-replace effort, national health insurance is more popular than not—most Americans now support Obamacare.
Still, as the GOP now knows, support for a bright shiny healthcare plan has a way of eroding once the voters start kicking the tires; as we all remember, the Democrats bled plenty in past years thanks to Obamacare. Indeed, they have never recovered their overall political strength.
And in fact, a closer look at the polls on single-payer reveals much variance in support, depending on the way the question is worded. One key nuance, for example, is the distinction between the idea that everyone has a right to health insurance—which is broadly popular—and the specific idea that the federal government ought to monopolize healthcare, as Sanders advocates.
The Pew Center, for instance, finds that 58 percent of Americans agree that healthcare is a government responsibility; yet within that number, 33 percent support single payer, while almost as many—25 percent—support a mix of public and private providers.
Yet without a doubt, Sanders-mania is strong on the left; the same Pew data finds that 64 percent of self-described liberals support single payer.
Needless to say, the media are jumping aboard the Bernie Bandwagon: “Why Bernie Sanders’s Medicare for All Plan Is Good Politics”—that was the exulting headline atop The New Republic. “The Obamacare Fight Is Over—Now It’s On To Universal Medicare,” headlined The Intercept, a lefty publication funded by a Silicon Valley billionaire. And FiveThirtyEight asked of the Sanders plan, “Is it going to become one of the central goals of the Democratic Party and a defining feature of the campaign of whichever Democrat is the party’s nominee in 2020?” And the answer came back, “This seems very likely.”
Not surprisingly, given this opinion-wave, more than half the Democrats in the House of Representatives have endorsed their own single-payer bill, which closely echoes Sanders’.
Indeed, support for single payer has become a litmus test for the activist left; that is, the folks who control the Democratic presidential nomination are demanding an oath on the issue.
So it’s little wonder that a growing number of Democrats thought to be seriously considering 2020 presidential bids—including Sens. Cory Booker, Kamala Harris, and Elizabeth Warren—have joined with Sanders. Yet these allies may have gotten on board the single-payer express too late: According to one new poll, Sanders himself is the leading choice to be the Democrats’ 2020 nominee.
We must observe: If President Trump, according to the latest RealClearPolitics average, is at 39 percent approval and 55 percent disapproval, then the prospect of a Democratic president in the White House in 2021 can’t be ruled out. And if that were to happen, then the push for Berniecare would dwarf the earlier pushes for Clintoncare, back in the 90s, and, of course, more recently, Obamacare.
Berniecare and the Budget
With that prospect, however distant, in mind, it behooves all of us—especially taxpayers!—to consider exactly what Sanders has in store for us. For his part, the Vermonter has been pushing his single-payer idea for years, even if he has turned coy, lately, as to the exact details—including how much his plan would cost. Yet as Politico noted, Sanders himself once estimated that the 2016 version of his bill would cost an additional $10.38 trillion over a decade; the publication cautiously added, “Other analyses estimated a much steeper price tag.”
To put these numbers another way, we can simply observe: in 2017 the annual National Health Expenditure (NHE) of the U.S., is estimate to be $3.5 trillion. So now, how much of that NHE would be absorbed by the federal government? (The feds currently spend about $4.1 trillion a year, and so we can see, Sanders’ proposal would just about double the federal budget.
Still, some of Sanders’ preferred numbers are easily available—if not always accurate. For instance, in his latest proposal, he starts with the baseline assumption that the U.S. spends $10,000 per person per year on healthcare. (We might footnote that the Kaiser Family Foundation calculates that per capita health expenditures for 2017 are about 10 percent higher than that—to $10,942.)
Sanders’ argument is that his program would at least somewhat pay for itself, as increased government expenditures for healthcare would be counter-balanced by decreased private-sector expenditures. Still, there are some 28 million Americans currently without health insurance, and the coverage, however justified, would cost a lot.
Of course, Sanders’ mission is far larger than just insuring the uninsured. He also wants to shift the 165 million Americans with private health insurance (employer-based or personal) onto a government system. And that would be, uh… complicated.
Indeed, in recent years, there have been several state-based attempts to establish single payer, including in Sanders’ home state of Vermont–and they have all collapsed. Just this year, in California, the Golden State’s single-payer plan was canceled even before it was scheduled to start.
To his credit, Sanders is up front about the possible taxes he might collect to pay for his national plan. For instance, as part of a long list of possible revenue-raisers, he starts off with a “7.5 percent income-based premium paid by employers”; that payroll tax, he estimates, would raise $3.9 trillion over ten years. Then there’s a “4 percent income-based premium paid by households,” which could generate $3.5 trillion. Also on the list is $4.2 trillion in “savings,” gained from the elimination of various tax breaks that currently exist to support the purchase of health insurance. Plenty of other possible tax increases are listed, too, including some aimed exclusively at the rich or at Wall Street.
Berniecare and the Border
And yet all those tax increases could prove to be inadequate, for one huge reason. And that is: There’s a whole huge world out there, full of people who would love to have free healthcare, and Sanders no longer has a plan for restricting immigration. And for that matter, neither do most Democrats.
To get a sense of where this might be heading, we need only look at a Breitbart News headline from September 15: “Nightmare: DACA Amnesty DREAM Act Will Cost $115 Billion Thanks to Obamacare.” And the reason is simple enough to understand: Adding more people to the Obamacare rolls costs money.
Of course, some will say that immigrants, legal and otherwise, add tax revenue. And to some extent, that’s true. However, as Breitbart author John Carney notes, “the median annual income of current DACA aliens is $32,000.” In other words, Uncle Sam might get some revenue from them—but not much.
So we can see: if Uncle Sam would be spending, per Berniecare, $10,000 or more per person, then spending can add up, bigly—as big as the new population that comes here.
As we know, the Democrats these days are no longer much interested in securing the border or policing illegal immigration. In fact, they have purged the word “illegal” from their vocabulary. Indeed, even the softer word “undocumented” has mostly fled their lips; they now refer blandly to “migrants.”
Moreover, the Democrats are now shy of the word, “citizen.” In other words, to the Democrats, the key concept is people, not citizens. And so if you’re a person who happens to be in America, for any reason, well, then, you should get to stay there—and draw benefits. That might not quite be the American Way, but it is, increasingly, the Democratic Way.
And yet since it’s a big world out there, full of billions of people who are not U.S. citizens, that could get expensive—really expensive.
If nothing else, Sanders is forthright in outlining the goal of his bill—it applies to everyone in the U.S., regardless of their legal status. As he declares on his senatorial website, “Every man, woman and child in our country should be able to access the healthcare they need regardless of their income.” Indeed, a search at all the available supporting materialon Sanders’ site finds not a single mention of that crucial word, citizen.
Yet one needn’t be an accountant to do some simple math: If the feds are going to start spending $10,000 per person for everyone’s healthcare, no questions asked, then it’s reasonable to conclude that such spending would be a significant magnet for people—especially those with serious medical conditions or pre-conditions—to come flocking here to America.
We might note that the left wasn’t always like this. Once upon a time, the parties of the left were restrictive on immigration, precisely because they knew that it would be impossible to maintain a costly welfare state if anyone could come from anywhere and soak up its benefits. That is, as generous-minded as leftists might have been, they weren’t dumb—they could count.
This historical hawkishness was true, as well, for the Democratic Party in the U.S. Indeed, as recently as July 2015, Sanders was one of those hawks, at least in theory. In fact, he was sometimes vehement about his stance. Early in the 2016 presidential campaign, he was asked by the left-leaners at Vox whether the U.S. should start looking at immigration policy through the prism of global poverty—that is, letting people come here as a way of alleviating their poverty. Sanders snapped back that such thinking was “a Koch Brothers proposal,” and a “right-wing proposal,” adding, “It would make everybody in America poorer.” The reason? It would lower workers’ wages.
With obvious heat, Sanders continued:
What right-wing people in this country would love is an open-border policy. Bring in all kinds of people, work for $2 or $3 an hour, that would be great for them. I don’t believe in that.
Indeed, the Vermonter even added a jibe at the interviewer’s open-borders notion that seems almost Breitbartian in its emphatic nationalism: “You’re doing away with the concept of a nation state.”
We might note that Sanders was 74 years old when he made these comments. So it seems fair to surmise that this assertive defense of U.S. sovereignty—at least as far as the protecting of workers’ wages and the preserving of the integrity of the welfare state—was his considered position. Once again, we can recall that such a stance was a standard part of the left’s solidarity message for more than a century; the legendary unionist, Samuel Gompers, co-founder of the American Federation of Labor, believed with all his heart that people shouldn’t just come to this country and start collecting benefits.
Yet Gompers died in 1924, and Sanders is alive and kicking—and ambitious. And so, confronted with the reality that the activist Democrats who would choose the party’s nominee in 2016 seemed at least as wedded to globalized multiculturalism as to national health insurance, Sanders, out on the campaign trail, quickly changed his tune. And today, if he is not the leading champion of, say, sanctuary cities, neither is he an opponent—in fact, he has voted to defend them.
In other words, in his heart of hearts, Sanders’ private position might well be that the border would have to be closed to make his welfare-state expansion viable. He is, after all, mostly an old-time solidarity leftist, as opposed to a new-style multiculturalist. And yet, of course, Sanders’ personal view don’t matter if he doesn’t express them anymore—what matters is his public position. And his public position is mostly indistinguishable from those of the open-borders crowd.
So with the costs to the welfare state in mind, we can ask: What are the dimensions of the illegal immigration issue, even now? In 2014, the U.S. government estimated that 22.3 million non-citizens were living in the U.S.
So how much are the taxpayers spending, already, on healthcare for people who aren’t citizens—most of whom aren’t supposed to be here? The answer is that nobody really knows for sure, although in 2013, the immigration hawks at the Federation for American Immigration Reform pegged the annual cost at $11 billion. That same year, the conservative Heritage Foundation projected that the annual cost of Obamacare for illegals could be $24 billion. To be sure, these numbers are hotly disputed; some on the right, as well as the left, insist that illegal immigrants add to the economy.
Yet all those calculations could be swamped, Hurricane Harvey-style, by the immigration wave that could be coming, especially if it’s clear that the border will be opened up.
According to a 2012 estimate by Gallup, 13 percent of the world’s adult population—640 million people—would move to the U.S. if they could. And of course, under the doctrine of chain-migration, that number of immigrants could easily quadruple in a few years’ time.
In other words, with a Sanders-style president spending more money on healthcare while not defending the border, you could take the $10,000 in per-capita health spending tab and multiply it by another billion or two people.
That’s a lot of money. So these are some of the stakes in the 2020 election. On immigration, Donald Trump might prove to be a disappointment—“Amnesty Don” was Breitbart’s headline, in the wake of Wednesday night’s DACA confusion—but Sanders, joined by many, if not most, Democrats, would be, by his own proclamation, an astounding cost-calamity.