Bernie Sanders  single-payer health care plan would raise U.S. health expenditures by billions of dollars, according to the Urban Institute.
Bernie Sanders single-payer health care plan would raise U.S. health expenditures by billions of dollars, according to the Urban Institute. (Darron Cummings, The Associated Press)

There is an elephant in the room that few like to mention when the high cost of U.S. health care comes up — especially in relation to what citizens in other countries pay. But thanks to Bernie Sanders' proposal for a single-payer government-run plan, the elephant is finally getting some attention.

Expert analysts who look at the Sanders plan have mostly concluded it would cost a great deal of money, and much more than Sanders insists.

One reason, to be sure, is his plan offers extravagant benefits compared to typical insurance coverage here and abroad. As The New York Times' Margot Sanger-Katz explains, "The Sanders plan would charge no premiums, require no out-of-pocket spending and would pay for services like dental care and long-term nursing home stays."

As a result, according to the Urban Institute for example, "National health expenditures [under Sanders' plan] would increase by $6.6 trillion between 2017 and 2026, while federal expenditures would increase by $32.0 trillion over that period" — way more than Sanders' campaign has projected.

But Sanger-Katz goes on to note that the obstacles for lower costs with a single-payer plan go much deeper than the design.

"Making the American health care system significantly cheaper would mean more than just cutting the insurance companies out of the game and reducing the high administrative costs of the American system," she writes. "It would also require paying doctors and nurses substantially lower salaries, using fewer new and high-tech treatments, and probably eliminating some of the perks of American hospital stays, like private patient rooms."


These causes of the cost of U.S. health care — and especially salaries — are rarely mentioned in policy discussions, and almost never by politicians. When the finger is pointed, it is much easier in this populist moment for politicians and even sober policy analysts to solely target insurance and pharmaceutical companies. But the salaries of hundreds of thousands of health care workers? That's a different and far more uncomfortable discussion.

And as Sanger-Katz indicates, health care facilities in this country typically include more amenities than those in other countries — and yet they are the sort of amenities that many Americans have come to expect. It's not clear we'd give them up willingly.

So the next time you hear someone say that we could dramatically reduce health care costs by adopting a single-payer system — which proponents of Amendment 69 in Colorado are saying right now, by the way — treat their assurances with at least some degree of skepticism.

Like most things in life, it's not nearly so simple.

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