Bernie Sanders says he can save Americans $6 trillion over the next ten years. The problem: To get there the economy may have to shed as many as 2 million jobs.
Cost savings is the essential pitch behind Bernie Sanders’ Medicare for All plan. Sanders’ argues that our health care system is hopelessly corrupt, and that our byzantine system of public regulations and subsidies and privately run insurance companies and providers was built to line the pockets of the well-connected, rather than provide the best health care at the lowest cost for the American people.
Sanders has a point. On average, Americans spend more on their health care, and get worse outcomes than pretty much every other country in the developed world. The Sanders plan works under the logic that if we adopt a health care system like Canada’s, U.S. health care costs would resemble those north of the border.
But he is less specific as to where the savings will come from. One area where we would undoubtedly save money is by cutting jobs in the health care sector, which currently employs about 9% of the American workforce. Kenneth Thorpe, a well-respected health care expert from Emory University says in an email that the number of folks who are employed by insurance companies and billing firms that could lose their job may number in the hundreds of thousands.
But Thorpe is relatively pessimistic about the Sanders plan’s ability to control costs, and argues that Medicare for all will be $1 trillion more expensive per year than its supporters think. The more optimistic you are about our ability to control costs through Sanders’ plan, the more job losses will result. Gerald Friedman, the University of Massachusetts Amherst economist whose analysis has undergirded much of the more optimistic arguments for Sanders’ policies, told CNNMoney that up to 2 million workers could be displaced under a single-payer regime.
The Hillary Clinton campaign hasn’t attacked Bernie Sanders over the fact that his campaign would cause insurance company workers to lose their jobs, and it’s not hard to see why. People don’t like insurance companies, and in all fairness, this extra administrative layer in the American system is one of the reasons why Americans get so little value for their health care dollar.
But she has attacked the practicality of Sanders effort to institute single-payer as something that is “never-ever going to happen.” And one of the reasons supporting this belief is the large number of Americans who would lose their livelihoods under such a plan aren’t going to take it lying down. They would form just one flank in a massive effort by the status quo to protect their interests.
In 2008, then Senator Obama recognized that such opposition would exist to even the most modest health care reform plan. That’s why he explicitly argued for giving insurance companies “a seat at the table” during negotiations over health care reform. He worried that if his reform effort was too oppositional towards business interests, they would ban together and convince the public to not support the plan, as they did during the HillaryCare debate in the early years of Bill Clinton’s administration.
Other single-payer healthcare proposals, like that from Representative John Conyers, have included funds that would help displaced workers find new jobs, with the Conyers plan setting aside $20 billion. It’s not clear, however, whether this would be enough to assuage the anger of such workers, and Bernie Sanders plan does not include such a fund.
None of this is to say that the U.S. economy wouldn’t be better off in the long run with a single-payer system. Evidence from other countries suggest it might. But the question of whether it’s politically possible to get there from here is one that should be on voters minds. Senator Sanders’ response to questions of political feasibility is that he will overcome opposition with the support of millions of new voters who will push through his political revolution. The great thing about this argument is that it’s eminently testable. Senator Sanders has the chance on Super Tuesday and in the contests that follow to prove whether he really can motivate millions of new voters to join the process. If that’s the case, we will be pushing a lot of health care industry workers out of jobs.