Bernie Sanders’ Presidential Medicare For All Bill

In his book, Our Revolution: A Future to Believe In, which I reviewed yesterday, Bernie Sanders devotes an entire chapter to the problem of healthcare. He states very clearly and in great detail why America a system of free healthcare, which he calls Medicare For All. He shows that 48 million Americans cannot afford health insurance, and those that can, still may not be able to afford to go to the doctor because of the complex system of deductions that are part of private health insurance policies. The costs of prescription drugs is artificially high thanks to the pharmaceutical companies, so that poor Americans may not be able to afford them. Despite the Republicans sounding off, like the Tories over here, about the importance of access to mental health care, this is all beyond the reach of many Americans. As is proper dentistry. I’m English. Orwell joked as long ago as the 1940s in his book The Lion and the Unicorn: Socialism and the English, how my people have bad teeth, and it’s a gibe that’s been made regularly by Americans ever since. But despite the shining whiteness of the toothy-pegs of Hollywood celebrities, even this is beyond many Americans. Sanders describes how dentists and dental nurses in one county in Virginia once a month treat patients free for a day. So desperate are people for this treatment, that they actually sleep over night in their cars.

America needs Medicare For All. Bernie included it as one of the planks of his presidential campaign. He gives the text of it in his book. Here it is.

Medicare For All:
Leaving No One Behind

Coverage

A federally administered single-payer health care p0rogram means comprehensive coverage for all Americans. This plan will cover the entire continuum of health care, from inpatient to outpatient care; preventive to emergency care; primary to specialty care, including long-term and palliative care; vision, hearing and oral health care; mental health and substance abuse services; as well as prescription medications, medical equipment, supplies, diagnostics, and treatments. Patients will be able to choose a health care provider without worrying about whether that provider is in-network and will be able to get the care they need without having to read any fine print or trying to figure out how they can afford the out-of-pocket costs.

What It Means for Patients

As a patient, all you need to do is go to the doctor and show your insurance card. A single-payer plan means no more co-pays, no more deductibles, and more fighting with insurance companies when they fail to pay for charges.

Getting Health Care Spending Under Control

We outspend all other countries on our health, and our medical spending continues to grow faster than the rate of the inflation. Creating a single, public insurance system will go a long way toward getting health care spending under control. The United States has thousands of different health insurance plans, all of which set different reimbursement rates across different networks for providers and procedures. This results in an enormous amount of paperwork and high administration costs. Two patients with the same condition may get very different care depending on where they live, the health insurance they have, and what their insurance covers. A patient may pay different amounts for the same prescription drug depending solely on where the prescription is filled. Health care providers and patients must navigate this complex and bewildering system, wasting precious time and resources.

By moving to an integrated system, the government will finally have the ability to stand up to drug companies and negotiate fair prices for the American people collectively. The government will also be able to track access to various providers and make smart investments to avoid provider shortages and ensure that communities have the providers they need.

Major Savings for Families and Businesses

The United States currently spends $3.2 trillion on health care each year – about $10,000 per person. Reforming our system, simplifying our payment structure, and incentivising new ways to make sure patients are actually getting better care will generate massive savings. This plan has been estimated to save the American people and businesses more than $6 trillion over the next decade.

The Typical Middle Class Family Would Save Over $5,000 Under This Plan

Last year, the average working family paid $4,955 in premiums and $1,318 in deductibles to private health insurance companies. Under this plan, a family of four earning $50,000 would pay just $466 per year to the single-payer programme, amounting to a saving of over $5,800 for that family each year.

Business Would Save Over $9,400 a Year
in Health Care Costs for the
Average Employee

The average annual cost to the employer for a worker with a family who makes $50,000 a year would go from $12,591 to just $3,100.

How Much Will It Cost?

This plan has been estimated to cost $1.38 trillion per year.

How Would It Be Paid For?

* A 6.2 per cent income-based health care premium paid by employers. Revenue raised: $630 billion per year.

* A 2.2 per cent income-based premium paid by households. Revenue raised: $210 billion per year. A family of four taking the standard deduction can have income up to $28,800 and not pay this tax.

Progressive Income Tax Rates

* Revenue raised: $110 billion a year. Under this plan the marginal income tax rate would be:

* 37 per cent on income between $250,000 and $500,000.

* $43 per cent on income between $500,000 and $2 million.

* 48 per cent on income between $2 million and $10 million. (In 2013, only 113,000 households, the top 0.08 per cent of taxpayers, had income between $2 million and $10 million).

*52 per cent on income above $10 million. (In 2013, only 13,000 households, just 0.01 per cent of taxpayers, had income exceeding $10 million).

* Taxing capital gains and dividends the same as income from work. Revenue raised: $92 billion per year. Warren Buffett, the second-wealthiest person in the country, has said that he pays a lower effective tax rate than his secretary. The reason is that he receives most of his income from capital gains and dividends, which are taxed at a much lower rate than income from work. This plan will end the special tax break for capital gains and dividends on household income above $250,000.

* Limit tax deductions for the rich. Revenue raised: $15 billion per year. Under this plan, households making over $250,000 would no longer be able to save more than 28 cents in taxes from every dollar in tax deductions. This limit would replace more complicated and less effective limits on tax breaks for the rich, including the alternative minimum tax, the personal exemption phaseout, and the limit on itemised deductions.

* The Responsible Estate Tax. Revenue raised: $21 billion per year. This provision would tax the estates of the wealthiest 0.3 per cent (three-tenths of 1 per cent) of Americans who inherit over $3.5 million at progressive rates and would close loopholes in the estate tax.

* Savings from health tax expenditures. Revenue raised: $310 billion per year. Several tax breaks that subsidise health care (health-related “tax expenditures”) would become obsolete and disappear under a single-payer health care system, saving $310 billion per year.

Most important, health care provided by employers is compensation that is not subject to payroll tax or income taxes under current law. This is a significant tax break that would effectively disappear under this plan, because all Americans would receive health care through the new single-payer, rather than employer-based program.

(pp. 334-8).

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