Medicare for all a tough sell

Now, Sens. Kamala Harris and Elizabeth Warren among others have joined Sanders in advocating for a single-payer health care system.

But is it plausible? Progressives like to point to Great Britain and Canada as two countries that have pulled off single payer without turning into socialist overlords.

Advocates for single payer say it would be relatively simple to change over.

The money spent on private health insurance and health care would be shifted to the federal government through some form of taxation.

The federal government then could set prices and force health care providers to accept current Medicare payment rates, which according to experts would be about 40 percent less than what private insurers pay hospitals and other providers.

Single-payer advocates say the new government-run system would mean everyone would be insured and people would access health care services more frequently because they would be free, perhaps without even co-payments.

What's not to like?

Well, there's this: the transition to single payer (Medicare for all) from our current system would be a rough ride.

The biggest issue is that would require the estimated 181 million Americans currently receiving health insurance through employer plans, of whom 70 percent say they're satisfied with their coverage, to trust the federal government to come up with something better and then to find the discipline to enforce spending cuts, while ignoring special interests who want to subvert the system. Members of Congress have an awful track record on all these counts.

And, many Americans don't have the same view of centralized big government as Brits and Canadians. Nor do most appreciate higher taxes.

Then there are the unavoidable system shocks from a public takeover of health care to hospitals, insurance companies, and doctors. And don't forget that the current health care system is a major employer in many communities. Physicians, nurses and other health care personnel would probably see their incomes slashed as payments were cut.

Patients would also have to make a major shift in their expectations. In Canada, the wait time between seeing a general practitioner and a specialist is far longer than in this country.

The Sanders single-payer plan would increase federal spending by about $32.6 trillion over its first 10 years. The Congressional Budget Office projects federal spending for the entire 2019 fiscal year budget of $4.4 trillion.

With Medicare for all, the taxes are upfront, and the projected savings come much later, which might explain why single-payer plans have not been adopted in liberal states, including California.

And if Democrats, already under fire for the utopianism of the Green New Deal, really want to re-elect Trump, they can ignore the Kaiser Family Foundation survey which reported that once respondents learned Medicare for all would eliminate private insurance and raise taxes, only 37 percent supported the idea.

Gov. Gavin Newsom is a progressive Democrat in good standing, and, as such, supports Medicare for all.

But Newsom in January also unveiled a practical plan that would add to the 2010 Affordable Care Act which Republicans have weakened but not overthrown.

Newsom's plan would reimpose the individual mandate congressional Republicans threw out in 2017. This state mandate would require every California to carry decent health care coverage or pay a penalty — similar to what Obamacare once mandated on a federal level. Restoring it in California would ostensibly draw younger, healthier people into the state's insurance pool, and thus keep costs down for all involved.

Newsom says the state plan would use the additional revenue from the restored mandate to expand the federal subsidies that currently help lower-income Californians who buy coverage on the individual insurance market to pay for their premiums. This would help people who don't get insurance from their employers but also don't qualify for federal individual market subsidies under Obamacare.

Stabilizing Obamacare on a state level is far more realistic than a costly and jarring Medicare for all government takeover.