The horizon is not so far as we can see, but as far as we can imagine

Single Payer Healthcare: Bernie Sanders vs. The Wonks


“Liberal wonks” have been sniping at Sanders healthcare plan: Single payer. In a single payer system, the government acts as the sole insurer for all basic medical needs. Think Medicare, except for everyone.

Single payer costs less than the American system–about one-third less. Take a look at the chart above and find the Canadian line. Notice what happens after Canada goes from a private to a single payer system—costs drop by about one third compared to the United States.

One can cavil about how Sanders will pay for single payer, but the fact is that it will cost Americans less than the current system.

A lot less.

The question then becomes: “Who will pay?” It makes no difference to a company’s balance sheet, or a person’s bank account whom they end up paying—private insurers, or the government. It only matters how much they pay.

Paying one-third less will be a win for everyone, except insurance companies, drug companies, and various health-care providers who price gouge, so long as it is intended that everyone win.

As for your coalition to get single-payer through, it is everyone not involved in the healthcare industry, and many people (like doctors who hate the current system) within the healthcare system.

Yes, insurance and drug companies, appliance manufacturers, private hospitals, and so on will spend an immense amount of money to campaign against single payer, but they are still a minority of the population and of businesses. There is a case to be made to every single non-healthcare company which currently offers insurance (these tend to be the large, more powerful businesses) to come out for single payer to save themselves money.

Single payer is a superior system. It costs less and produces better results on most metrics. Anyone who tells you otherwise is either lying, or has no idea what they are talking about.

“Wonks” who pretend otherwise through tedious arguments, are deceptive at best, making their bones within the system at worst. Or not actually competent “wonks.”

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Open Thread (Primaries)


  1. Wonks have to make money to.

  2. Mary M McCurnin

    Wonks need to make money to pay for their health care.

  3. Dan Lynch

    If single payer/private provider is superior, then why does the UK public provider system have 50% lower cost than Canada? Ditto other countries with public provider systems, like Finland?
    If single payer/private provider is superior, then why is America’s Medicaid — which is a single payer system — notorious for poor service and dishonest billing?
    Stop touting single payer/private provider as the holy grail. Single payer does not take the profit motive out of health care.
    If you believe that profit motive has no place in providing health insurance, then why do you believe that profit motive has a place in providing health care?
    Do you also private provider for schools? For water and sewer? For roads? For national parks? For prisons? Etc.
    There is no logical consistency behind single payer/private provider. Either you believe in the private, for-profit system, or else you believe in public services. Make up your mind, and be consistent.

  4. Tom

    When things were bad enough, 60,000 Democrats had their party affiliation changed without their consent and were disenfranchised in New York.

  5. V. Arnold

    Dan Lynch
    April 19, 2016

    Ian said; “Single payer is a superior system. It costs less and produces better results on most metrics. Anyone who tells you otherwise is either lying, or has no idea what they are talking about.”

    @Dan; if the shoe fits, wear it. Especially the last 9 words…

  6. Ian Welsh

    Single payer is superior to what America has. It is not necessarily the best system, period.

    Medicaid does not work because it is part of a hybrid system where it is not in the interest of everyone to make it work. Universal single payer works because everyone needs it to work.

    Neither public provision nor private provision is always the best.

    However we are discussing SANDERS proposal. Which is to say universal single payer. Not whatever system you think we should be discussing.

  7. Some Guy

    “Stop touting single payer/private provider as the holy grail. Single payer does not take the profit motive out of health care.”

    Dan, I set you a simple task (depending on where you live).

    1) Go to Canada go to a Doctor’s office (single payer)
    2) Go to a Dentist’s office (private)
    3) Compare and contrast

    For those who haven’t experienced this dichotomy, your standard doctor office is in a run of the mill building with functional decor while your standard dentist office is in much higher end real estate with paintings and soft lighting and plush carpet and an array of gee whiz latest and greatest machinery which doesn’t really do all that much.

    And it is not just the physical office which differs, one is much more likely to be marketed to and upsold/crosssold/oversold in a dentist office, than in a doctor’s office.

    Also, with respect to cost, there are basically 2 categories: The U.S. and the rest. Differences within the rest are relatively minor.

    For what it’s worth, the biggest area where Canada’s costs are higher than others is with respect to pharmaceuticals, which is the one area where most of the cost is covered privately, so you are right that even in Canada we could save by making our system ‘more public’ but that only strengthens Ian’s point.

    For those who are interested in the numbers, the OECD Health Indicators at a Glance is free online and contains most of what anyone might even want to know on the topic of comparative health care in the OECD countries.

  8. Better or not, we cannot switch to it because, accoring to Obama, it “would be too disruptive.” Interesting concept. Canada made the transition without much of a problem, but we are not as capable as Canada. Oh, wait, that can’t be right; we are the “exceptional” nation, the world’s leader. Why can Canada do things that we cannot?

  9. Mike

    As an outsider – is Sanders not proposing a US NHS because having a state-provided health care system is a step too far even for him?

    Also nice to see that the NHS is more efficient than the US and Canadian systems. That must be why the Tories are so keen to privatise it.

  10. John

    If the Tories Americanized the NHS,..just think how much free money there would be for the City types to skim with insurance for sick and suffering people. Its like the bank robber, when asked why he robbed banks, replied ” because that’s where the money is”

  11. EGrise

    “Exceptional” only counts in H-bombs and regime change.

  12. reslez

    Correct, Mike. Sanders doesn’t propose a public provider system like the NHS. He wants something closer to Canada, single payer with private doctors where the government pays the bill. Right now the US has a mishmash of systems — public provider for the Veterans Administration, single payer for the elderly and destitute, and private sector health care deniers in the profit-gouging insurance industry for everyone else.

    D. Lynch: “Do you also private provider for schools? For water and sewer? For roads? For national parks? For prisons? Etc.”

    Hahaha. It’s all here, and it’s all terrible. Charter schools. Privatized utilities (see Flint, MI). Toll roads. Angry ranchers grazing on public land. Privatized prisons. If you don’t already have these things in your country, fight very hard to make sure you never do.

  13. Some Guy

    “Also nice to see that the NHS is more efficient than the US and Canadian systems. That must be why the Tories are so keen to privatise it.”

    Have to be careful about assuming that cheaper = more efficient. While it’s performance overall is reasonable, the U.K. system scores below Canadian one on almost every quality of care / results metric (but ahead of the U.S. of course) – as an example, the OECD report I referenced above suggests that poor cancer care is a reason why life expectancy (at age 65) for women in the U.K. is much worse than in other developed countries (like Canada).

    Given results showing that as society gets wealthier, one of the few areas of spending that still generates happiness (or mitigates unhappiness) is health spending, it’s not necessarily efficient for a wealthy society to spend less on health and get (even slightly) worse outcomes. Not that I’m saying Canada’s choices are necessarily better than the U.K.s, but – aside from the obvious conclusion that the U.S. system is awful – international comparisons among the rest are more complicated.

  14. Ian Welsh

    The change was disruptive. There were huge mobs of doctors protesting, among other things.

    But we were better off afterwards.

    The system has issues, no question, but it’s better than the US system.

    The drug problem is compounded by all the idiot “free trade” deals with their ridiculous IP laws.

    The NDP has proposed a universal drug care benefit, but Trudea has abs and Moslem women wear hijabs, so we decided that pissing on Muslims and admiring a pretty boy were higher priorities.

  15. different clue

    @Dan Lynch,

    CanadaCare may not be “pure public” but it is better than what Americans outside of huge legacy employers who give quality coverage to their workers have now. And since Obamacare is carefully designed to raise the penalties against huge legacy employers giving quality coverage to their employees over the next few years, through such devious means as the so-called “cadillac care tax” against merely adequate employER health coverage plans, growing millions of Americans will be forced onto coverage deeply inferior to CanadaCare.

    CanadaCare would be a good first step up from the present and planned-future American system. If we could get that, then we could always decide later if we want to go Full Metal Public.

    Someone should study the history of Medicare employment and staffing over the past few decades. If Medicare has been systematically de-staffed, and esPECially its fraud-detection units systematically de-staffed; then of course Medicare would provide worse service and let more fraud go undetected. Those outcomes would be designed on purpose, in order to fake a case against Medicare.

  16. different clue

    One cause of high American health care spending which is not discussed enough is the low state of American health and wellness. This has many causes. Two very simple causes to understand would be body-attriting pollution of various kinds, and the other cause would be 300 million Americans eating shitfood all the livelong day. A steady intake of shitfood leads to a steady outcome of shit health. (The other 30 million Americans are probably spending the money — guided by knowledge — on shinola food. Those 30 million other Americans are eating shinola food all the livelong day and their input of shinola food leads to an outcome of shinola health.)

  17. vcx

    When things were bad enough, 60,000 Democrats had their party affiliation changed without their consent and were disenfranchised in New York.

    The lawsuit looks like it’s intended to fail–even if, as seems unpleasantly likely, foul play is responsible, it’s hardly probable that a court would institute a sweeping revision of NY electoral procedures as a remedy.

    A more limited remedy like postponing the NY primary or just delaying or extending the Brooklyn poll would be much more likely to be granted.

    Are they seeking suchlike at least as a fallback position? If not I smell a ratf***.

  18. Hugh

    Not sure what the big selling point of consistency is. Two of the highest rated healthcare systems in terms of satisfaction, cost, and outcomes are the French and Australian ones, both single payer, private provider. How about doing what works and what people want?

    As for Sanders, I think he is toast after New York. It was a strange campaign. When he started, he wasn’t a serious candidate, and it wasn’t a serious campaign. It was like putting out a small soapbox where he could raise a few progressive talking points on the way to the Hillary Coronation. There was a space there for him because of the deafening contempt and indifference emanating from the Clinton camp on all things progressive. Clinton tolerated Sanders because she didn’t consider him to be serious. After all, Sanders had a well deserved rep in Washington for folding like a cheap lawnchair. And there were plusses. A Sanders candidacy would suck out the energy, money, and support from any real progressive alternative to her. So far from undercutting TINA, he reinforced it. And as he had already promised to support the eventual Democratic nominee, which to Hillary and her courtiers could only mean her, they saw him as nothing more than a useful sheepdog to herd in the progressive base they intended to use and discard.

    But then to the surprise of Sanders and the shock and anger of Clinton, the Sanders candidacy took off because there is a lot of discontent in the country, Sanders’ message spoke to that discontent, and suddenly this marginal candidate was not only viable but could pull an upset. It is hard to fathom what the reaction of Hill and Bill was to this. You have to understand that the Clintons are grifters to the core. And the first rule of the con is to never, ever admit the con, but my, how the pressure did show in Hillary’s forced, cracked china smiles and Bill’s angry petulance. They live in a world where entitlement and paranoia go hand in hand and are as normal as sunshine. Sanders’ support and successes pushed the buttons on both into overdrive. Hillary and Bill would slash and bash Sanders and then whine like little puppy dogs being beaten with a stick at any criticism real or imagined coming from Sanders.

    What they couldn’t stop though was that the more people saw and heard Sanders the more they liked him, and the more they saw of Hillary the even more they disliked her. That is the Achilles heel of the Clintons. Hillary has no concept –it just doesn’t register–how much she is disliked. As for Bill, insulated and disconnected in his lofty Clinton Initiative world, he was like an aging playboy once the charm is gone going through all of his old moves. It would have been embarrassing but was mostly dislikeable, and kind of creepy. But hey, it doesn’t have to work. It just has to work enough, and this is the last shot at a big con by this exhausted and constipated duo.

    You may be thinking that I have forgotten Sanders. If you watched the news like I did, you should be used to this. A standard news roundup of the campaigns would be TRUMP, TRUMP, TRUMP, followed by all of the Republicans, and then turning to the Democrats, HILLARY, and then at the very, very end a few seconds of Sanders, white haired and waving his arms at a podium. People who heard Sanders liked his message. The problem was his message wasn’t getting out. I remember seeing campaign coverage of Sanders on cable news just before the New York primary. They left the sound on long enough so that Sanders was just at the point of actually making a good point, and the control room literally killed the sound, and then cut away.

    Sanders could have learned a few lessons from Trump. He could have prefaced his main talking points with “This is what the media don’t want you to hear!” This is like waving a red flag at the media. They can’t ignore these kinds of challenges and will report them, at length, despite themselves, and despite how much they try to bend and twist it, the message gets out. And when the media did confront Sanders on some issue, like whether Clinton was qualified to be President, he should not have backed down. His answer should have been “I misspoke. I did not mean no. I meant Hell no!” Same thing with breaking up the banks: “As President, I would have a lot of power to break up the banks, to make them smaller. If I needed any further authority, I would go to the Congress. What part of this is hard for you to understand? Or do you like the idea of banks gambling with their depositors’ money and placing the whole economy at risk?” But Sanders didn’t do this and doesn’t do this. And this exposes the limits of his approach and his candidacy. There is no such thing as a genteel revolution. You can not make an omelet without breaking eggs. Sanders is an insider running as an outsider inside the system. The level of cognitive dissonance in that is astounding. He wants to overturn the system without disturbing it, or upsetting anyone. He wants to remake the Democratic party and the country but without criticizing Obama, even if that means validating Hillary Clinton, two of the warmongering neoliberals most responsible for why the country and the Democratic party are in the state they are in.

    Sanders’ candidacy went a lot further than everyone, especially Sanders, thought it would. His candidacy (and Trump’s) was useful in the sense that it exposed in detail just how rigged, corrupt, and anti-democratic the Presidential selection process is. I sat down recently and wrote up a list of the rigging. And general as it was, it came to more than a page. Between this rigging and the media blackout, it is now clear, barring a Clinton indictment, that Sanders will not be the Democratic nominee. The question is what comes next? I only see two choices. Sanders stays true to his followers, rejects Clinton, and breaks with the Democratic party or he assumes the role of sheepdog that many of us considered him to be when he started his campaign.

  19. EmilianoZ


    that was an epic comment, very funny too. I hope you will post the list of all the cheating and rigging somewhere.

    It seems that Sanders was trying to walk the tightrope between fighting for his ideals and not upsetting the Dem hierarchy. I fear the result will be that he will lose on both sides. He will lose his credit with the progressives and the Dem hierarchy will not forgive him, especially if Hillary loses the general. He had his few months of glory but in the end it’s gonna be a footnote in a history book. Too bad he was not prepared to cross his Rubicon.

  20. Mallam

    I don’t know if you understand this, Hugh, but Barack Obama is extremely popular…within the Democratic electorate itself. How does one attack that which is popular, with a 86.7% approval rating ?

    The fact is that unless you find a candidate who can appeal to an AA constituency of at least 40%, you’re not going to win in the Democratic primary. And according to you the best way to do that is to attack, feverishly, the most popular person in the world within that constituency?

    What a terrible argument. Sanders had a tightrope to walk. I think he could have gone after the Clinton Foundation — that’s where the attacks for the picking are located. He also should have gone after her more on FP, which he consistently avoided. The I/P was a great exchange. More like that, but with other topics (her Russian aggression, which she jabbed in there when discussing fracking).

  21. V. Arnold

    April 21, 2016

    I thought Hugh did quite a good job of fleshing out Bernie’s pluses and minuses; the minuses out numbering the pluses, by a fair margin. Bernie failed on many fronts.
    Your poll results for Obama are skewed to the dems only; but here in another poll by RCP’s is quite another result.
    You can play the numbers game all you like; but Obama is not popular with the majority.
    I think he sucks. And so does U.S. politics in general; until there is major reform in the voting laws; voting is for fools…

  22. Mallam

    You moved the goalposts. Talk about cherrypicking. Overall approval includes Republicans, third party, and everyone in between (including Democrats). Last I checked, Bernie Sanders is running for the Democratic nomination. And within the Democratic Party, people of color have a lot of influence. Barack Obama is very popular within the Democratic Party (which is where the contest is at this point in time) to the point of 85-90%, and that’s among all Democrats. Among people of color within the Democratic Party, his numbers are higher than that.

    Now, Hugh said that a great strategy to attract the people Sanders needs is to attack the most popular person among that demographic. Someone trusted within that demographic. Yeah. No wonder the left has no strength.

  23. V. Arnold

    April 21, 2016

    Goal posts? You set the first one and I do not agree with its position; because it set’s a false narrative of the reality of the present political situation in the U.S..
    I’ll not argue this further; we’ll just have to agree to disagree…or not; either way, I don’t care…

  24. tony

    Have you ever argued with the opponents of universal healthcare, Americans or European libertarians? I have had several arguments, and it always goes the same. The basic argument goes about this: “It would cost less” “Don’t care, have healthcare already” “You would pay less in total, look at the numbers from other countries” “But America has black people, you can’t prove me wrong.”

    Everyone who has cursory understanding of politics understands the arguments for single payer. Everyone that has opposed it, has admitted that it’s about black people. Some have said ‘diversity’ or other code. It’s racism, pure and simple. So I don’t think rational arguments hold much weight to the opponents of single payer.

  25. CH

    Did Sanders really lose New York? If the electoral data is bogus than any discussions premised on it will just carry us even further down the rabbit hole.

  26. Tom


    Yes Sanders lost. 120,000 Democrats who could have sung the vote his way were purged from the roles illegally by having their party affiliation changed without their consent.

    Millions of New Yorkers were disenfranchised by the Closed Primary Rules which required them to register a Party last year in October before Sanders had even begun to run.

    Even Trumps kids were disenfranchised and couldn’t vote for him and it meant Trump lost Manhattan his Home District. While carrying all the other districts.

    This election is characterized by rigged voting and disenfranchisement of voters by the Democrats to coronate Hillary.

  27. Ian Welsh

    I’ve put up an open thread. Please discuss the primaries there.

  28. different clue

    The PrivaProfit Big Insura conspiracy contains and sustains enough people that opposition to Single Payer can number close to a million just from the Running Dog Lackey Flunky Stooges of Big Insura opposing Single Payer in order to protect their own Iron Rice Bowls. Racism need not be invoked in their cases. Senator Max Baucus was not motivated by racism, for example. Neither was Obama, so far as I know.

  29. CH

    @Tom: Read the article. This is about people who could cast ballots. The pre-“adjustment” exit poll discrepancies are far, far outside the “close enough to steal” grey area of the 2000 and 2004 generals. This is daylight robbery.

    @Ian: I’ll do so but I reiterate that any debates over what led voters to “choose” a particular candidate are fatuous and counterproductive if the candidate in question was chosen by Diebold executives and not by voters.

  30. Jeff W


    Everyone that has opposed it, has admitted that it’s about black people. Some have said ‘diversity’ or other code. It’s racism, pure and simple.

    This paper by Alesina, Glaeser and Sacerdote (2001) bears that out. The authors say

    Our bottom line is that Americans redistribute less than Europeans for three reasons: because the majority of Americans believe that redistribution favors racial minorities, because Americans believe that they live in an open and fair society and that if someone is poor it is his or her own fault, and because the political system is geared toward preventing redistribution.

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