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.