Bernie Sanders’ health care revolution would come with a lot of question marks. 

Sanders has staked his campaign for president on a platform of converting the U.S health care system into a $14 trillion single-payer program run by the government. His opponent for the Democratic nomination, Hillary Clinton, has criticized the cost and the political feasibility of his plan, but Sanders makes it sound simple: If Europe can do it, so can we. 

“There is only one way that I know of that you can provide universal, cost effective and comprehensive health care for all of our people,” Sanders said in 2009 while ACA was being debated in the Senate. “That is a Medicare for all singer-payer system.”

Sanders has not yet offered key details about what such a system would look like if he were to enact it, such as how much it would pay doctors and what treatments would be covered. Those details could all significantly change how people use health insurance and how much it would cost the government. 

Experts say it’s not so simple, in part because no large free-market country, not in Europe or even Canada, has ever tried what Sanders is proposing — to socialize an industry that accounts for nearly one-fifth of the national economy.

The lack of detail makes it very difficult to estimate how his plan would change the economy. So does the lack of any comparable historical precedent for what he is proposing. 

The trend in capitalist countries since the 1970s has been to liberalize previously state-run industries, such as airlines and telecommunications providers. Sanders would do the reverse, putting a full government umbrella over a health care industry that is nearly 16 percent of the U.S economy. 

Other Western countries, such as Denmark, the United Kingdom and much of continental Europe, all launched their government-administered health systems before a large private health insurance sector could take root. 

The National Health Service in the U.K was born as the country struggled to recover from the destruction of World War II. Many of the country’s doctors were spread out and working in service to the government during the war and it was an easy and seamless transition to a system that would grow to provide nationalized health care for more than 64 million British citizens.

Canada is the best and most recent example of a country attempting a health care plan similar to the one Sander’s proposes, Glied said. The Canadian system evolved over decades from a universal plan that started in a single province in the 1940s.

In the absence of details and analogues, experts are left to guess at the effects of Sander’s plan. The Sanders campaign has embraced a forecast of the plan’s potential effects produced by Gerald Friedman, an economist at the University of Massachusetts-Amherst, which some liberal economists have criticized as unrealistically optimistic. 

Friedman predicts Sanders’ proposals would speed U.S economic growth to as fast as 5 percent per year – up from a post-recession average of 2 percent – in part by dramatically increasing incomes and spending power for the middle class. 

In an email interview, he predicted the plan would produce “losers as well as winners” in the American workforce. “Health insurers would either fold or be dramatically scaled back,” he wrote, as would companies providing billing services to health-care providers. Pharmaceutical companies would see their profit margins shrink, he said, though they would still be profitable. 

Friedman estimates 600,000 workers could lose their jobs across the economy, but that 98 percent of them would find new employment within two years.

The winners, he said, would include health care providers who no longer would need to worry about some patients never paying for services; employers outside the health sector, whose savings from no longer providing health insurance would outweigh new taxes to help fund the program; and workers who will pay less for care and potentially earn more as employers pass some health spending savings on in the form of higher wages.

Other economists say the effects would be more complicated, depending on how much the single payer system pays for patients’ care. 

If a typical singer-payer benefit is not much more generous than basic Medicare benefits, said Timothy Layton, an economist at the Department of Health Care Policy at Harvard Medical School, “I don’t think the entire health insurance industry would disappear.”

Instead, he predicted, the industry is likely to cater to higher income Americans who can afford supplemental insurance coverage, or who seek treatment from health providers who decide not to accept singer-payer benefits at all. 

Higher-income consumers in Europe and other areas with single payer plans are increasingly buying such supplemental coverage, said Scott Atlas, a doctor and health care researcher who is a senior fellow at Stanford University’s conservative Hoover Institution think tank. Under an American single-payer plan, Atlas said, health care “will be driven toward two parallel systems with even more inequality” between rich consumers and everyone else. 

Layton said some workers who lose jobs in the transition to supplemental care could find work in the federal government, administering the new single-payer plan, or for health providers themselves. They could also find work, he said, “in a large industry of firms that help providers game the system and extract as much as they can from the government.”

Government estimates of the cost of health care spending also have a history of being completely wrong. Early studies of the cost of Medicare were off by billions of dollars and the Obama administration continues to grapple with shifting ACA budget expectations. 

Hillary Says, “Let’s Build on Obama”

“I’m not going to let them tear up that law, kick 16 million people off their health coverage and force the country to start the healthcare debate all over again.” 

Clinton says she will:

     •Defend the Affordable Care Act and build on it to slow the growth of out-of-pocket costs. 

     •Crack down on rising prescription drug prices and hold drug companies accountable so they get ahead by investing in research, not jacking up costs.

     •Protect women’s access to reproductive health care, including contraception and safe, legal abortion.

In response to complaints about limited plan and doctor options under Obamacare, last week Hillary revived an idea of allowing people 55 and over to buy into Medicare.

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