IS BERNIE SANDERS RIGHT?
“MEDICARE FOR ALL” IS PROBABLY THE best-known plank in Senator Bernie Sanders’ campaign platform. He wants the federal government to take over private health care insurance and replace it with a comprehensive, single-payer program. Under this plan, every U.S. resident would automatically be insured for nearly every contingency—hospital stays, dental care, mental health, ambulance services and long-term care, among other things—with nearly no copays or deductibles. Grandma needs a nursing home? That’s covered. Your son needs counseling for a drug addiction? Covered. No surprise bills, no copays.
Critics slam the plan as too expensive; Sanders insists it would save money overall. Everyone agrees, however, that Medicare for All would amount to a massive transfer of spending from the private sector to the U.S. government. And there lies the rub. Can the U.S. government be trusted to manage a complex, fast-moving industry in which innovation and efficiency—qualities more often associated with the private sector than a government bureaucracy—are matters of life and death for so many Americans? The question makes many people nervous and puts Sanders’ supporters on the defensive.
What goes largely unappreciated in this debate is that the U.S. government already owns and runs one of the most successful health care operations in the world. It’s taken on the care of millions of some of America’s most challenging patients, including residents of isolated rural communities and older patients who need long-term care. It does so while eliminating many of the racial disparities that haunt American health care. It trains most of America’s doctors. It is a leader in telehealth, electronic health care records, precision medicine and many other important, forward-looking technologies. It earns quality-of-care ratings that most hospitals would envy. It keeps costs generally below average and charges most patients little or nothing.
The system is the Veterans Health Administration—commonly referred to as the VA, after the broader agency that runs it, the U.S. Department of Veterans Affairs—along with the Walter Reed National Military Medical Center, operated by the Defense Department. Walter Reed serves about a million active-duty military personnel, military retirees and others. The VA serves about 9 million patients, the vast majority of whom are U.S. military veterans. It provides government health care on an enormous scale, entirely administered, delivered and paid for by the
