The problem with Sanders plan is that it assumes GIGANTIC cost savings simply from taking private insurers out of the picture. And sure, there's some "wasted money" there, from things like advertising and profits and executive salaries. But it's hardly a huge cost driver in our system. If you want prices like you've got in Europe, then you need HUGE cuts in payments to hospitals and doctors. You don't need Medicare for all, you need Medicaid for all. And that means bankrupting tons of rural hospitals, tons of doctors quitting because their salaries are going to be decimated, and it means a significantly lower standard of care than a lot of middle-class and upper-middle class people are used to.
Alternatively, you can not go after these massive cost savings, but then you'll either need much higher taxes than Bernie is calling for OR gigantic deficits.
Yeah, there is really no money out there by nixing insurance companies. There is some money in making it illegal for drug companies to price discriminate against US customers as compared to foreign ones. That is why the US basically subsidizes drug research for the planet. It's financed by the higher prices US customers pay. The other source of savings, is by going full throttle, the pedal to the metal, towards an HMO system, where there is no financial incentive to over-treat patients. Medicare is moving that way, but it needs to go all the way. If those two things are done, US medical care will still be more expensive (because it has lower wait times and better service than most single payer systems in Europe), but the gap will substantially narrow. That is the way out of the box, to the extent one can get out of the box, for a product that due to medical technology, is now a very expensive one relatively speaking, and due to the aging population.
I dislike single payer because it cuts off options. I want to be able to fire my doctor, and if necessary, pay more for better service. The idea that you either get mediocre service, with very limited options, and the only alternative is to go elsewhere and pay for it all, while you pay nothing for the mediocre service, leaves me cold. Just give medical subsidies for medical insurance for an HMO service provider product, on a means tested basis. That to me is what is sensible and fiscally realistic.
That's my two cents on the matter.
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