It is frequently stated that the current Republican Congress is ineffective in getting anything done. That is not entirely true.  A big issue was decided this past summer.  The failure of Congress to repeal and/or replace the Affordable Care Act means that the goal of universal healthcare for all Americans is here to stay.

The question now is the best way to implement universal healthcare.  Senator Bernie Sanders (D, VT) has just introduced a single payer universal plan, “Medicare for All.”  Here are some of the problems associated with such a plan:

• At least three states, Vermont, Colorado and California have recently rejected state-wide single-payer plans because of the huge costs involved.
• The Urban Institute estimates that Medicare for All would increase federal spending by $32 trillion for the first ten years (compared to a very high current total national debt of $20 trillion).
• Medicare is an inefficient hidebound system with over 140,000 procedure codes where private sector cost-saving measures, like competitive bidding for routine services, are rarely used.
• There are now 155 million Americans who receive and like their employer provided health insurance and who will resist moving to a Medicare for All plan especially at the cost of a huge tax increase.

On the other hand the cost of healthcare in the U.S., public and private, now eats up 18% of GDP, almost twice as much as for any other developed country, and major changes need to be made to give individuals more direct responsibility for the cost of their own healthcare.
One attractive alternative is to limit the tax deduction for employer provided care to the cost of catastrophic coverage, at a cost of about $3000 per person per year.  It could be made progressive by tying deductibles to income.

Conclusion. Healthcare spending in the U.S. is way too high and something major needs to be done. Universal catastrophic care for all Americans not already covered by Medicare and Medicaid is an attractive alternative to single-payer Medicare for All.

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