'How Will You Pay for It?' Bernie Sanders Tackles Key Question on Medicare for All

Sen. Bernie Sanders is not ducking the key question constantly posed to Medicare for All supporters by journalists, fellow members of Congress, and critics: "How will you pay for it?"

In a white paper (pdf) released Wednesday alongside the 2020 contender's updated and improved Medicare for All legislation, Sanders' office outlined a number of possible funding mechanisms for the comprehensive bill and detailed the enormous savings the U.S. would reap by transitioning to single-payer.

"Every major industrialized nation on Earth has made healthcare a right, provided universal coverage to all, and achieved far better health outcomes in terms of life expectancy and infant mortality rates—all while spending far less per capita than we do," the paper states. "Please do not tell us that the United States of America, the wealthiest nation in the history of the world, cannot do the same."

The paper lists a number of policy changes that could help raise revenue for Medicare for All, including:

  • A 70 percent top marginal tax rate on Americans earning over $10 million per year;
  • A 77 percent top tax rate on estates above $1 billion;
  • A tax on "extreme wealth";
  • A "fee on large financial institutions";
  • A "7.5 percent income-based premium paid by employers, exempting the first $2 million in payroll to protect small businesses"; and
  • A four percent "income-based premium paid by employees, exempting the first $29,000 in income for a family of four."

While acknowledging its list is not exhaustive, Sanders' office said the U.S. has a large "variety of options available to support a Medicare for All, single-payer healthcare system."

"Under every single one of these options the average American family will save thousands of dollars a year because it will no longer be writing large checks to private health insurance companies," the document says.

The white paper also emphasizes the massive savings American families and the U.S. overall would reap by transitioning from the wasteful for-profit system to Medicare for All, which would eliminate premiums, deductibles, and co-pays.

"'How are you going to pay for it?' That is the question that bookends nearly every media conversation that takes place on Medicare for All," the paper states. "The straightforward answer is, we already are."

"Unlike other government outlays—for example, a ship for the Navy—Medicare for All does not represent any new spending at all," the document continues. "Instead, it represents a rebalance of how our current dollars are spent."

Under the for-profit status quo, Sanders' office points out, the U.S. federal government is on track to spend $59.65 trillion on healthcare between 2022 and 2031.

By contrast, according to two studies published last year, Medicare for All would cost the U.S. significantly less while providing comprehensive healthcare to all Americans.

"According to estimates from the conservative Mercatus Center, under the Senate's Medicare for All legislation, [national healthcare] expenditures will drop by approximately $2 trillion," the paper notes. "Another study released by PERI at the University of Massachusetts found that 'Medicare for All could reduce total healthcare spending in the U.S. by nearly 10 percent,' resulting in more than $5 trillion in savings."

Medicare for All would also save the U.S. money by slashing prescription drug costs, Sanders' office argued.

"If the U.S. joined the rest of the industrialized world and negotiated with the pharmaceutical companies to lower prices, our country could save up to $113 billion per year," the paper states.

The paper closes with a call for "vigorous debate" on the ideal path to funding Medicare for All.

As Vox's Sarah Kliff noted, the items offered by Sanders' paper "could no doubt be used to finance a national healthcare system."

"But eventually," Kliff added, "someone is going to have to pick which items on this list become law—and that's where things get tough."

"Unlike the Republican leadership in Congress which held no hearings on their disastrous bill which would have thrown 32 million people off of health insurance," Sanders' office concludes, "we will continue to get the best ideas from economists, doctors, nurses, and ordinary Americans to guarantee healthcare as a fundamental right."

The white paper was released as Sanders officially introduced his Medicare for All legislation with the support of 14 Democratic co-sponsors and more than 60 progressive advocacy groups.

"The American people are increasingly clear," Sanders said in a statement. "They want a healthcare system which guarantees healthcare to all Americans as a right. They want a healthcare system which will lower healthcare costs and save them money. They want a healthcare system which will guarantee them freedom of choice as to which doctor or hospital they can go to."

"In other words," the Vermont senator added, "they want Medicare for All, and that's what we will deliver to them."

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