Ezra Klein came out with this while we were all watching the debate. And note: he was very critical of Hillary’s recent criticisms of Bernie on healthcare.
The main points of his discussion of Sander’s plan:
Sanders is detailed and specific in response to the three main attacks Clinton has launched, but is vague or unrealistic on virtually every other issue. The result is that he answers Clinton's criticisms while raising much more profound questions about his own ideas.
...It's everything critics fear a single payer plan would be, and it lacks the kind of engagement with the problems of single-payer health systems necessary to win over skeptics.
- The numbers are optimistic and depend on cost savings that are questionable (as detailed in subsequent points)
Of course, these new taxes replace the premiums Americans pay now. And here, Sanders promises that between shifting health care financing to the rich and cutting costs through single payer's efficiencies...
Those benefits are big. To get them, Sanders is assuming some immense cost savings. And that's where the problems start.
- The tax plan will have adverse impact on the economy
In general, I'm comfortable with higher taxes on the rich — though they've risen substantially in the Obama era already — but tax increases of the scale Sanders proposes here would begin to have real economic drawbacks...Sanders's effort to fund a universal health-care system so heavily on the backs of the wealthy would be unprecedented.
- It’s not Medicare for All
Sanders calls his plan Medicare-for-All. But it actually has nothing to do with Medicare. He's not simply expanding Medicare coverage to the broader population — he makes that clear when he says his plan means "no more copays, no more deductibles." Medicare includes copays and deductibles. The list of what Sanders's plan would cover far exceeds what Medicare offers, suggesting, more or less, that pretty much everything will be covered, under all circumstances.
- Sanders says no more fighting with insurance companies, but fails to acknowledge that now we will fight with government, the way Medicare recipients do now
But the implication to most people, I think, is that claim denials will be a thing of the past — a statement that belies the fights patients have every day with public insurers like Medicare and Medicaid, to say nothing of the fights that go on in the Canadian, German, or British health care systems.
What makes that so irresponsible is that it stands in flagrant contradiction to the way single-payer plans actually work — and the way Sanders's plan will have to work if its numbers are going to add up.
- Sanders does not explain when claims will be denied, and who will decide what gets paid for
But to get those savings, the government needs to be willing to say no when doctors, hospitals, drug companies, and device companies refuse to meet their prices, and that means the government needs to be willing to say no to people who want those treatments.
The issue of how often the government says no leads to all sorts of other key questions — questions Sanders is silent on.
- If private insurance is still allowed, this diminishes the negotiating power of the government, which reduces the savings
many systems that get mentioned during discussions of single payer, like the French system, include various kinds of supplementary, private insurance that people generally purchase.
The role of private insurers matters because it drives the government's bargaining power...But if there are private insurers selling add-on policies to wealthier Americans, then drug companies can deal only with them, and the government's negotiating power wanes.
- How will he guarantee access to care, when hospitals and other providers will close their doors if forced to pay Medicare rates for all patients
If the entire system is squeezed down to Medicare pricing, a lot of hospitals are going to close. How will Sanders keep that from happening? Or will he let it happen, even if it means people in rural areas need to drive hours for care?
- For a program that would be disruptive, much more detail is needed, even for a campaign proposal
The easy rejoinder to this is that this is just a campaign proposal, and these are details that can be worked out in the legislative process. I disagree. Sanders is proposing a huge, disruptive reform here — he owes the public answers to the most central, obvious questions about how that reform would work.
- It’s “puppies and rainbows”
In the absence of these kinds of specifics, Sanders has offered a puppies-and-rainbows approach to single-payer — he promises his plan will cover everything while costing the average family almost nothing.
It’s worth reading the whole thing.
If Bernie is serious about a single-payer plan, he has a lot of explaining to do.
Also worth looking at: Ezra Klein’s article What Liberals Get Wrong About SIngle Payer
And an article Klein tweeted out today, from Vox: Here's why creating single-payer health care in America is so hard
UPDATE: If you have been seized with a burning hatred for Ezra Klein after reading this, you might want to click through to the diary I cited above, from last week, in which he attacked Hillary’s criticism of Bernie on healthcare, and see if you reccd it. It was on the reclist, and republished by Team Bernie.