Senator Bernie Sanders often claims that other countries’ experience with health care shows that his Medicare for All plan makes sense. He’s at it again today, tweeting, “Remember: our ‘crazy idea’ of universal health care is a reality in” a long list of countries. The thing is, most of the people who think Sanders’s plan is crazy do not think it is crazy because it is impossible to have universal health coverage. They think that his plan is extremely unrealistic and cannot live up to the promises Sanders makes.
So, for example, almost none of the countries Sanders mentions has a single-payer system, which is what he wants. Nor do they eliminate co-pays, deductibles, and premiums. Sanders points to the fact that other countries have higher coverage and lower costs than we do to show that his system will keep costs under control — while abjuring one of the methods other countries use to keep costs under control. Single-payer systems also tend to have bigger problems with wait times than other universal-coverage systems. So it’s a sleight of hand to suggest (as some defenders of single payer do; see previous link) that Sanders’s plan won’t lead to such problems because other countries, run on different lines, don’t have them.
Also, none of those countries started with a health-care system that is as large, developed, and costly as ours and then tried to socialize it. So they didn’t run into the political economy problem of dealing with well-paid doctors and powerful hospitals, a problem that single-payer enthusiasts have not figured out how to solve. Can you extend coverage to more people, make coverage more generous for nearly everyone who already has it, and keep total costs on par with what we already spend? Not without draconian cuts to providers that the advocates don’t want to defend and that, partly for that reason, are exceedingly unlikely to happen.