The bill specifies that Medicare would be run with an annual budget, leaving government officials to decide how to make the country’s medical spending conform to such totals every year. It also says that the government should evaluate the effectiveness of different medical treatments. Such a system has precedent: Several countries, including Canada and Britain, establish health care budgets that must be met and assess the value of medical services to determine what should be covered. But such budgets and limits have been politically toxic in the United States, where politicians have been reluctant to say that the government should restrict care. The Affordable Care Act established a theoretical limit on spending per Medicare beneficiary, establishing a board that would reduce costs if a cap were met. But that board, assailed as a “death panel,” has never been called upon to make such choices, for no members have ever been nominated to it. Mr. Sanders sells the bill as a broad expansion of care, by ensuring that all Americans have similar, broad benefits and little financial exposure to medical bills. At Wednesday’s event, he stood flanked by several prominent Democratic co-sponsors and medical providers who offered testimonials about how a Medicare-for-all plan would improve access to needed health care. The plan increases the generosity of Medicare substantially. It adds coverage for dentistry, optometry and audiology care, not part of the traditional program. It also eliminates premiums, deductibles and most co-payments for medical care, which are significant costs for many people. The size of the Medicare budget is also unspecified. In part, that’s because the Sanders bill does not establish a funding mechanism for its planned overhauls. In a separate white paper, Mr. Sanders’s office spells out some possible revenue sources, including increases to payroll taxes, and to high-end income taxes and some corporate taxes. But those funding streams, politically risky in their own right, would need to be debated and measured before the realistic scale of the Medicare-for-all budget would be clear. This different Medicare would face the push and pull of expanded reach and fixed means: one that would tend to increase the cost to the government for care, and one devised to reduce it. Just what sort of Medicare program results would depend on the government that runs it.
In his big new single-payer health care bill, Senator Sanders says he wants to turn the country’s health system into “Medicare for all.” But his bill actually outlines a system very different from the current Medicare program.