A new study from the Mercatus Center at George Mason University has just said that Bernie Sanders’ “Medicare for all” plan would cost the federal government some $32.6 trillion in its first decade. But Mercatus is funded by the Koch brothers, so we can ignore that, right? Well, actually, that estimate isn’t out of line with other estimates. Providing top-notch healthcare for a lot of people, the entire population, is simply an expensive undertaking. The problem is that Sanders and other such visionaries are trying to square the circle without taking the difficult decisions necessary to do so.
Free at the point of use healthcare, with no delays and no rationing, isn’t something that any country has, nor likely ever will. Something, somewhere, has to give. What gives is a political choice, but it’s still one that has to be made.
The usual comparisons of medical healthcare systems come from the Commonwealth Fund. As with every measurement system, it’s designed to flatter their favored answer (In this case, free at the point of access healthcare like Britain’s National Health Service). Just a little historical note about that: the instigators believed that it would become cheaper over time as historic illnesses were cleared up. Yes, that of a system which has grown from about 3 percent of GDP to about 10 percent today.
Thus the measurement system majors on things like equity of access, “fairness” of financing and so on. There is a measure of actual treatment quality and that’s the one the NHS fails dismally on, as the U.S. fails on that fairness part. Actually, the NHS fails badly on “mortality amenable to healthcare” or as we might also call it, ability to cure people. Perhaps it’s not the greatest model for a healthcare system, then.
[Also read: Here’s everything wrong with Alexandria Ocasio-Cortez’s delusional tax reform ideas]
Our basic problem is that no one really wants to die. Therefore, demand for healthcare is pretty much unlimited. Something has to be the limitation upon it. In the NHS, it’s treatment delays. The target is (and note that it’s a target not always met) that you start getting treatment for cancer by two months after your doctor thinks you might have it. Other systems deal with matters in a different way. Sweden, that democratic socialist delight, insists upon a copay to see your general practitioner. Near all other systems are some combination of insurance and government subsidies to the poor.
The American system, as we know, offers excellent and very fast treatment (usually described as the world’s best, in fact) to the great majority who can pay for it, and leaves some portion with rather worse healthcare services.
Which particular system is chosen is a political decision. But the idea that we can have everything is simply nonsense. That current choice and speed of U.S. healthcare for that majority cannot be extended to all at a price that anyone is willing to pay, not without some form of rationing of access to the system through copays or delays.
Quite literally no one has managed to square this circle elsewhere. There are systems which offer a different mix than the current American one, but none that are perfect, nor any that offer what Sanders promises us. It’s just not an option that the universe allows us, unlimited and excellent healthcare on someone else’s dime.
All of this is before we decide to hand over healthcare to the same people who bring us the DMV, or that government provided healthcare as dismally as in Department of Veterans Affairs hospitals. Entirely tax-financed, no-copay, excellent, speedy, healthcare for all doesn’t exist anywhere. Clearly, Sanders has not found the secret either.
Tim Worstall (@worstall) is a contributor to the Washington Examiner’s Beltway Confidential blog. He is a senior fellow at the Adam Smith Institute. You can read all his pieces at The Continental Telegraph.
