'SandersCare' doesn't pass the laugh test

'SandersCare' doesn't pass the laugh test
© Greg Nash

On Sep. 13, Sen. Bernie SandersBernie SandersSanders has right goal, wrong target in fight to help low-wage workers Democrats in standoff over minimum wage Sanders votes against Biden USDA nominee Vilsack MORE (I-Vt.) introduced legislation disingenuously labeled the “Medicare for All Act of 2017.” This proposal, which is yet another repackaging of old fashioned socialized medicine, is the wrong prescription for our current healthcare ills.

Unlike the current Medicare program, which is limited to the elderly, disabled and those meeting disease-specific criteria, such as chronic renal failure, Sen. Sanders’ plan would provide “comprehensive protection” to all “residents” of the United States.


Traditional Medicare requires substantial patient financial contributions in the form of Part B premiums, Medigap insurance to cover significant limitations in Medicare coverage and what can be large out-of-pocket costs for prescription drugs.


Medicare Advantage plans offer broader services with what are typically modest patient copayments and deductibles.

By contrast, "SandersCare" would offer a broad swathe of services, including hospital inpatient and outpatient treatment, pharmaceuticals, mental health and substance abuse treatment, audiology, vision care and more, mostly without patient cost sharing.

The Sanders plan outlaws private and employer-based insurance, transferring those health care costs to the federal government. Given the present fiscal state of the Medicare program, Sanders’ program fails the laugh test.

Since its inception, Medicare has exhibited poor cost control and unbridled growth. The program is riddled with fraud. A 2015 Government Accountability Office report estimated that over 10 percent of program funds, or 60 billion dollars, are squandered on fraud, waste, abuse and improper payments.

According to the Medicare Trustees, the Hospital Insurance Trust Fund will become insolvent in 2029, and substantial future tax increases will be required if the Supplementary Medical Insurance Trust Fund is to meet its obligations.

Despite this undeniable reality, Sen. Sanders and his co-sponsors propose to miraculously give complete coverage to an additional 270 million people, while absorbing the costs and removing the constraints associated with copayments and deductibles.

What about freedom of choice? Sanders preserves the present fee-for-service system, although maintaining the strong federal push toward alternative payment models. However, any impact of payment structure on patient options would likely be dwarfed by the effects of the national health budget the Senator’s proposal creates.

If this fantastical scheme could somehow be implemented, the severe financial constraints it brought with it would remove any hope of preserving even a modicum of patient and provider flexibility and choice.

In the inevitable fight over the distribution of grossly inadequate resources, services would be severely rationed. Like most battles over scarce government dollars, politics would govern allocation, with the most powerful, best-connected companies, entities, diseases and causes disproportionately benefiting at the expense of the rest of us.    

What of the development of new drugs and devices? As with other elements of Sanders’ bill, his inclusion of price controls on pharmaceuticals and medical supplies, a prescription drug formulary and a requirement for use of generic drugs may have superficial appeal.

The costs to the untold number of patients who would never benefit from the novel, lifesaving medical products that would never come to fruition are incalculable.

In sum, Sen. Sanders health-care plan would inappropriately move our system further away from the competition and market forces that can most effectively reduce costs, improve quality and ensure access to high-quality care for all Americans.

Sanders’ brand of socialized medicine would be fiscally unsustainable. It would interpose government bureaucrats between patients and their doctors, curtailing patient and physician autonomy, lowering quality, politicizing delivery and creating shortages of essential and desired services.

Rather than the Sanders approach, Congress needs to undo much of the legislation known as ObamaCare and inject the system with true market-based reforms. Only by following this course will our nation successfully contain costs, improve quality and guarantee that all Americans have access to the world's best medical care.

Dr. Roger Klein is principal at Klein and Klein Co., L.P.A. and Roger D. Klein, MD JD Consulting, providing legal services, litigation support and medical, scientific and business consulting in the areas of regulation, intellectual property CPT coding and reimbursement, compliance, industry analysis and due diligence for the genomics, biotechnology, health care, clinical laboratory and financial industries.