The Rich Are Different From You and Me

James Freeman makes an observation about Bernie Sanders’s version of “Medicare for All” in his Wall Street Journal column. After quoting the relevant passages he observes:

The legislation does have a provision for private contracting for medical services, and assuming doctors, patients and nurses obey the various rules for such contracts, there would be a path for some small amount of non-government health care. But remember insurance products and corporate plans are not allowed to compete against the broad coverage promised by the government plan. And the Sanders bill prohibits private contracts “entered into at a time when the beneficiary is facing an emergency health care situation.”

So there would generally be no escape for patients who realize too late that they will die before they get to the front of the line for necessary care. But for someone who does not require insurance and is willing and able to pay cash for any needed services—and who contracts ahead of time to cover possible needs in a way that complies with the Bernieaucracy—there appears to be a narrow path to high-quality service. But how many Americans are financially capable of paying cash for any needed medical care?

We already have several different classes of health care in this country. That’s a decision that was made a half century ago. The classes include those on Medicaid, those on Medicare, those whose employers pay for their health care insurance, those whom the federal government subsidizes, and those who pay for concierge medicine. I’m sure that some will protest that the standard of care ensures that everyone gets the same level of care but the reality is different.

Under Sen. Sanders’s plan (as well as under the “Medicare for All” Act already pending in the House), those classes would be greatly narrowed. Under the present system most in the middle class have a pretty good level of care available to them. Under M4A there would be two classes: those who can pay cash and everybody else. What level of care “everybody else” would actually receive is presently unknown. You can assume the best or you can assume the worst.

I should also point out that, based on the snippets quoted by Mr. Freeman (particularly this: “the automatic enrollment of individuals at the time of birth in the United States or upon the establishment of residency in the United States”), the plan raises the prospect of people in the country illegally being covered by it which would seem to me to be a non-starter. That could be fixed by amending it to read “legal residency” but that could well be a non-starter for other reasons.

8 comments… add one
  • Andy Link

    I don’t get why M4A proponents are so set on destroying the private insurance industry and turning a M4A plan into a UK-style insurance system, only with private providers.

    It’s equivalent of banning pensions, 401k’s and IRA’s because of Social Security.

    If you have M4A, there’s no need to ban private insurance – after all, private insurance isn’t a serious competitor to those who are now eligible for Medicare and private insurance can provide wraparound or specific coverages that one-size-fits all government insurance cannot.

  • Simple. That’s where they think the savings to pay for it all will come from.

  • Gray Shambler Link

    So often”level of care” comes right down to immediacy of care. I believe it was Mark Steyn who pointed out, in Canada and the U.K.,
    it helps to have a $50 bill in your hand when you approach the emergency room front desk.

  • CuriousOnlooker Link

    I don’t believe having money in hand helps much in an emergency room in Canada, and I have experience in that regard.

    In Canada, the law forbids paying to skip a queue for medical treatment. It also forbids charging for “add-ons” in medical treatment. The things you can pay for are non-medical, like a private room instead of a shared one.

  • steve Link

    Guess people here are not acquainted with waiting times in US emergency rooms. Anyway, for the hundredth time, health care in Canada and the UK is much cheaper than ours, and the people there like it better. Quality is pretty much the same.


  • and the people there like it better

    Americans would probably like our system more if we produced the same sort of propaganda campaigns the Brits have for the last 60 years to promote NHS. For the most recent example, see Call the Midwife, an hour-long infomercial for NHS. The Brits are pretty good at selling their systems.

    As I’ve mentioned before I need to schedule checkups a year in advance. If I have a serious problem, they’ll see me quickly but anything else must be scheduled a year in advance. The practice isn’t accepting any more patients.

  • steve Link

    Maybe, but it is not as if we dont spend tons of money on advertising. We are spending about $30 billion/year on advertising in health care. Last stats I saw showed the NHS spending about $8 million/year. If Call the Midwife is propaganda what was ER? Trust me, no ED doc ever did the stuff they did on that show, or most any medical show.

    Still, even if you dont think Marcus Welby was propaganda and the Brit show is propaganda, the UK has the larger differential. They spend almost half of what we spend. Let’s cut US spending in half, then try playing shows about how wonderful some nurses were in 1950. Think Americans will then love our health care? (Nearly all US medical shows end providing a pretty positive view of medial care and the people who work in health care here in the US. You get an occasional villain and individual episodes that might be negative, but I cant think of any show that was, on net, negative. Will admit I dont watch much TV anymore.)


  • Gray Shambler Link

    And in America, the law forbids paying to skip a queue for college admission, that’s why it never happens.

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