Is Sanders Proposing Serious Legislation or a Rallying Cry?

One of the big stories today is that Sen. Bernie Sanders (I-VT) will release his single-payer bill. He has planned a news conference for 2 pm EST to do so.

In the meantime, the senator has released an executive summary of his plan. The best rundown I’ve seen on it so far comes from Amanda Michelle Gomez. There are some significant things that have changed since Sanders released a single-payer plan during the presidential primary, and others that remain the same.

Perhaps the biggest change is that this time around Sanders has proposed a gradual process for implementation over a four-year period. The first step makes the slogan “Medicare for all” a reality by basically changing the health insurance program for the elderly into something more like Medicaid in terms of coverage. It also incorporates the proposals that expand the age of eligibility.

Within the first year, the bill would expand traditional services covered under the government-run Medicare program to include prescription drugs, dental, vision, and hearing aids. Residents older than 55 and younger than 18 will become eligible for Medicare within the first year of implementation.

Eligibility is then expanded further in years two to four.

In the second year, eligibility for Medicare would be extended to people older than 45; in the third year, the eligibility threshold would move down to 35. By year four, anyone who is a resident of the United States would be entitled to enroll in Medicare — though it’s unclear how the drafters intend to define “resident.”

Otherwise this bill is similar to the one that Sanders put forward during the primary. It includes expansive coverage with no co-pays or deductibles for anyone. As Sarah Kliff points out, that makes Sanders’s plan more generous than the single-payer plans of other countries—including the Canadian system that the senator often points to as a model.

So far, Sen. Sanders hasn’t released any information on the big question: how will all of this be paid for? His office said that they “would release a set of financing options later Wednesday afternoon.” But they are already signaling that they don’t really know.

“There’s nobody who has all of the answers,” Sanders told my colleague Jeff Stein when asked about the financing of his health plan. “Nobody has all the answers. What I can say is we are going to be listing a number of revenue-raising proposals, which will generate more than enough money to pay for what we want to do.”

It is important to keep in mind that the total cost of such a system is only one issue to be addressed. As Kliff says, “who pays how much more [in taxes] is a key question this Sanders bill doesn’t answer.” That leads Charles Gaba to this conclusion:

…this strikes me as a completely symbolic bill, meant purely as a showpiece/rallying cry for the Democratic Party about the direction that they should be pushing (hard) regarding healthcare going forward. The general message here is, “The ACA got us started down the field, now it’s time to focus on running the ball all the way into the end zone”.

That is essentially what I’ve been saying as we watch liberal Democrats in both the House and Senate endorse the bills put forward by Sanders and Conyers, while recognizing that we are more likely to get there via the incremental steps that are also being put on the table by Senators Brian Schatz, Chris Murphy, and Sherrod Brown.

Nancy LeTourneau

Nancy LeTourneau is a contributing writer for the Washington Monthly.