Bernie Sanders’ ‘Medicare-for-all’ plan promises comprehensive healthcare coverage for the entire continuum of healthcare, from emergency care to mental health services. Under this plan, patients would be free to choose their own healthcare provider without gatekeepers to limit access to specialists. Everything would be paid for by the government. There would be no out-of-pocket costs.  According to Sanders, his plan would reduce US healthcare spending by about 20%, mainly through administrative efficiencies and the power of a single payer to negotiate lower prices for drugs. That would have been a savings of about $740 billion in 2018 (20% of $3.7 billion).  

Unfortunately, cheaper drugs and administration would not come even close to paying for Sanders’ Medicare-for-all plan. That’s because the high cost of US healthcare is driven by over-testing, over-treatment, overpriced procedures, and overpaid doctors. Check it out:

_2019 Cost Per Person per Year Per Procedure.png

And now this* :

_2019 Five-Country Comparison.png

Now for a few ideas on how to reduce healthcare spending in the US:

  1. Stay with a multi-payer system, but with strict cost controls, like Japan and Germany.

  2. Develop fee schedules for diagnostic procedures, treatment, and medical equipment, set by federal or regional governments, like Japan and Canada. Public and private payers would use the same fee schedule, streamlining the medical billing process and saving on administrative costs.

  3. Increase medical fraud prevention, detection, and prosecution.

  4. Greatly expand the number of nurse practitioners as independent primary care providers and gatekeepers to specialists, as is already happening in the US and several European countries but needs to be ramped up a lot more.

  5. Institute a no-fault medical malpractice system, like the one in Denmark.

  6. Develop federal guidelines for medical testing and treatment, much like the NICE system in Britain, which would reduce defensive medicine as well as malpractice claims. As in Britain, medical providers would still be allowed to  depart from guidance per their independent judgment of what’s best for the patient.

These ideas have been worked out in much greater detail in previous posts (here).

* The “Ten Procedures” refers to information in the prior chart.

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Links and References:

Bernie Sanders' Medicare-for-all Plan

International Health Care System Profiles 

OECD Health system characteristics Survey 2012 and Secretariat’s estimates; Information as of April 2014

OECD Health Working Paper No. 104. Which Policies Increase Value for Money in Healthcare? April 10, 2018;

“Out-of-pocket medical expenditure”, in Health at a Glance 2017: OECD Indicators, OECD Publishing, Paris.

Kringos DS, Boerma WGW, Hutchinson A, et al., eds. Building primary care in a changing Europe: Case Studies.Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2015.

Papanicolas I, Woskie LR, Jha AK. Health Care Spending in the United States and Other High-Income Countries. JAMA. 2018;319(10):1024–1039. doi:10.1001/jama.2018.1150. and saving on