Sen. Bernie Sanders (I-Vt.) introduced a new single-payer bill on Wednesday to the delight of universal health care activists across the country. The big story was that Sanders’ legislation had the co-sponsorship of 16 Democratic colleagues, including virtually all who are considered presidential contenders.
It was a true milestone, demonstrating how far the debate on health care has moved inside the Democratic Party. A comparable bill Sanders introduced in 2013 got no support at all in the Senate.
But now that the bill is out, the hard part begins. Revolutionizing a system that encompasses over one-sixth of the United States economy will require grinding, unglamorous work, not least due to the resistance such an overhaul will encounter from those people who benefit from the status quo ― or who are merely afraid of losing what they already have.
When I sat down with Sanders on Tuesday, I wanted to know why now is the right moment to press for single payer, how he plans to accomplish the task and whether single payer is the only end goal or merely a blueprint for achieving universal coverage. With that in mind, I began by asking him why he did not propose a universal health care system with more than one insurer. Countries such as the Netherlands and Switzerland achieve universal coverage through a highly regulated system of private insurers that perhaps offers a better model for transitioning from the Affordable Care Act.
Below is a transcript of our conversation, with light edits.
HuffPost: Why not the Dutch system? Why not the Swiss system?
Oh Jesus Christ! All right, well, you can invent the Dutch system. [laughs]
We have a dysfunctional health care system now. Despite 28 million Americans having no health insurance, despite even more being underinsured, despite paying the highest prices in the world for prescription drugs, our health care outcomes are not particularly good. Our life expectancy is lower than many other countries and our child mortality, our infant mortality rate is even higher.
Our job right now is to rally the American people to understand that we are the only major country on Earth not to guarantee health care. And I think the Canadian system serves as a good model. We are like Canada in many respects. We are larger than Canada, we are more diverse ― but people are familiar with Canada.
They have a system that has been in place for 30 years. It has its problems. But what it has managed to do is provide health care to every man, woman and child as a right, and do it for less than half per person. So we think that’s a pretty good place to start.
Is there something about the simplicity of it, too?
Well, of course, and that’s true of any system.
What we are looking at now are several questions. Number one ― and this debate needs to take place ― should health care be a right of all people, or is it a privilege? I think most Americans think it is a right and that every American should have health care, period.
Number two, if you reach that conclusion, the next question you ask is, “OK, how do you provide health care to all people in a cost effective way?” The truth is, there are a number of ways to do it. You could provide health care to all people in the current dysfunctional system. It would cost a fortune.
It seems to me that the most cost-effective way to go forward is to expand what we already have in this country, which is a successful and popular program called Medicare, and say that it should not be people aged 65 years of age and older who are eligible for that program, but all people.
So what this legislation is about is to say that we will provide Medicare for all in a four-year period. In the first year we will lower [the] eligibility age to 55, bringing over 40 million Americans into the program. We will guarantee health care to all children under 18 and we’re gonna improve Medicare for older people, by the way. We’re going to expand that program to dental care, to hearing aids and to vision issues, as well, which is not covered by Medicare. So we’re going to improve Medicare, expand it in the first year to people 55, and to all kids. And then the next year it goes down to 45, the next year it goes down to 35 and in the 4th year it covers everybody.
We think this is the simplest, most straightforward way to guarantee health care to all people. Sen. Bernie Sanders (I-Vt.)
We think this is the simplest, most straightforward way to guarantee health care to all people.
To answer your question, one of the issues that does not get talked about that much, and that is exactly the issue that you raised, and that is the complexity of the current system. The reason that Social Security is a popular program ― is not only for what it does, providing retirement security to older people ― or Medicare is a popular program, is its simplicity.
You walked into a Canadian clinic, people just walk in. They don’t have to fill out a million forms. They don’t have to negotiate, decide which insurance company they want. They have freedom of choice with regard to doctor, with regard to hospital. We can save ― one of the problems we have in America, we have hundreds of different plans that have to be administered, all right?
So you may have a $5,000 deductible. You get Blue Cross Blue Shield, he has United, and the medical people have got to administer all these programs at huge cost.
Single payer means one program for all Americans and you lower the cost substantially. Also, you begin and have negotiations with the drug companies to substantially lower the cost of prescription drugs in America. You put money into primary care and disease prevention and all those things, you lower the cost of health care expenses in America significantly.
So I looked at the transition period and I understand that Sen. [Kirsten] Gillibrand, that was one of the things that she cared about ―
We all care about it ― look, we negotiated this ― our goal from day one is to develop a strong, effective program. I would not have done this if it wasn’t the case and I think we have that. Number two, I am one United States senator and I can choose anything I want and be one co-sponsor, but I gotta work ― and I should work ― I mean this is an effort, we have worked for the last four or five months with 19 different offices in the United States Senate, and we did our best to negotiate with each office and address their concerns. So Gillibrand had a concern, Elizabeth [Warren] had a concern, this one had a concern, that one had a concern ― everybody has a concern. That’s fine. That’s the way it should be. And we think what we have is a product that we should feel pretty good about.
Is there anything that surprised you about that process? Or about now, how it’s going gangbusters?
Yes. I think what we are seeing is something very, very interesting ― and that is, you’re seeing it in polling, you’re seeing it in town meetings, you’re seeing the American people waking up and demanding that we end this dysfunctional system and we join the rest of the industrialized world.
And what people here on Capitol Hill are sensing when they go out into their communities is that this is not an idea, in a sense, that’s being pushed from Washington, or from me. It’s being pushed by the American people who are saying, “We are tired of spending so damn much.”
I don’t know your circumstances, but you’ve got a family of four that’s spending $15-20,000 a year on health insurance and the projection is those numbers are gonna go way up. It is unsustainable. It is insane. We should not be spending twice as much per person as every other country.
So I think there is just a growing consensus that the ACA did some very good things. It provided insurance to 20 more million people. It dealt with obscenities like pre-existing conditions, et cetera, but it did not go far enough and the Republican solution of throwing 23 million people off insurance is obviously insane and the American people said “no” to that. So if we have a situation where the ACA did some good things, but did not go far enough, in the sense that many problems remain in terms of the number of uninsured and high cost of prescription drugs and high cost of deductibles and high co-payments, and the Republican alternative was totally insane, where do we go from here? Well, this is the logical conclusion.
That’s what people are thinking and that sentiment is filtering into Washington. And that’s why we have ― what have we got now?
Aide: 15. [The following day, Sen. Jeanne Shaheen (D-N.H.) became the 16th co-sponsor.]
Sanders: It’s still early. We may pick up a few more before the day is over.
[Sen. Joe] Manchin was saying they should have hearings on it.
And there you had [Sen.] Max Baucus. Are you familiar with that?
Here’s Max, the architect of the Affordable Care Act! And I had to take ― I’m on that committee, I’m on the HELP Committee ― and I had to take physicians, single-payer physicians, into his office, who said, well, why won’t you at least hold hearings on single payer? “Ah, I can’t do that.”
But Max has changed his point of view as well. That’s good.
If we were to play this out a little bit, 2020 comes ― a dream scenario, Dem president, Dem Congress. I’ll play it up even a more ― liberal Supreme Court. I don’t know how that would happen.
One option is, this happens right away. I don’t play down that possibility ―
Not right away, you mean after ―
After all that, in that new scenario with majority power.
Another option is, you’ve got moderate holdouts. It creates room for things that are kind of in the bridge area. What if we end up, 10 years from now, with something that more resembles ― again, forgive me, but ― a Dutch-type system or regulated nonprofits? Do we stop there?
I don’t want to speculate what’s gonna happen in 10 years. I can barely figure out what’s gonna happen tomorrow or the next two hours.
This is all I can say: What our job now is to do, and by the way, what’s important for you to understand is we have 15 co-sponsors, but we also have dozens ― equally important ― dozens and dozens of grassroots organizations who are in support of this legislation. Just today we got the Machinists Union. And I’m confident we’re gonna have other unions. We’ve got MoveOn.org, DFA. So you’re gonna have unions, you’re gonna have grassroots organizations and ultimately, to answer your political question, this is not gonna be won, this legislation is not gonna be won just here in the halls of Congress. It is going to be won in communities all over this country, when people begin to stand up and tell their elected officials, “Sorry, the status quo is not working and we want all Americans to have health care in a cost-effective way.”
So what we are doing is, we understand that the opposition to this legislation will be incredible. It will come from the insurance companies, the drug companies. It will come from Wall Street. It will come from the corporate media. We fully anticipate that and they have unlimited sums of money.
I was out in California campaigning for Proposition 61. You know what that is? That was the effort to lower the cost of prescription drugs in California. Do you recall that?
Yeah, yeah, I do remember that, actually.
The pharmaceutical industry spent $130 million to defeat one proposition in one state ― $130 million in California alone.
What do you think they’re prepared to spend on a national campaign?
Well, they’ve got patent monopolies. Their margins are pretty good.
They will spend unlimited sums of money. We know that.
So what we understand is this legislation does not get passed unless there is in fact a political revolution in this country, unless millions of people get involved, stand up and fight back.
And we are beginning to see this.
You know, it’s funny. This afternoon, I met with some Latino leaders. A young woman, I’m guessing 25, she said, “Bernie, I’m a member of the school board in Tempe, Arizona.” She says: “You got me involved in politics. I ran for the school board and I won.”
We are seeing that all over the country ― people getting involved. So we are going into this campaign, this effort, understanding this is not old-fashioned politics where I gotta lean on somebody ― but we gotta do that, too ― but ultimately this is a fight that is going to go into every community in America. And we will win it, when grassroots America stands up and is prepared to fight back, and I think that is happening every day.
One piece of this that would seem at least potentially politically challenging is that you still have 49 percent of the country that gets their health care from their employer. Many people are not happy with it, but a fair number of people are and they’re worried ―
Of course ―
They would be worried about losing what they’ve got.
What we have to do tomorrow, are you going to be at the event tomorrow?
I’m planning on it, yeah.
Good. You’re gonna hear from a guy who owns a business in Pennsylvania ― his name is Mr. Masters ― it’s a $200 million a year business. And what he would say is, he is tired of spending so much time and energy worrying about health care when he manufactures windows ― or whatever he manufactures ―
Aide: It’s picture frames ―
Sanders: Picture frames. That’s what he wants to do ― the picture frame business. And you’re going to hear from businesses all over this country who are saying, “We want to do our business and not spend an enormous” ― which they do. If you’re a small- or medium-sized business, the amount of time that these folks spend, negotiating, deciding which company they want to go to, which plan they want to go, negotiating with the company, it takes an enormous amount of time and energy. They want to do their business. And nationally, we’re at a competitive disadvantage to other countries where all workers have health care as a right.
This legislation is not gonna be won just here in the halls of Congress. Sen. Bernie Sanders (I-Vt.)
The point is there will be a lot of distortions about what we’re trying to do. The difference for the average person is that instead of having a card that says Blue Cross Blue Shield, or United Healthcare, there’ll be a card that says “Medicare for All,” or whatever the card will look like. And you’ll be able to go to any doctor you want, you’ll be able to go to the same doctors you’re going to now ― in fact, you’ll have more freedom of choice, because right now as you know, you are limited ― what’s the word that I always forget?
Aide: To the in-network ―
Sanders: Right, to your network of doctors. So if you want to go to a doctor not in your network, you can’t go. Under this plan, you will be able to go wherever you want.
So, in the business department, is it fair to say, it’s a pro-capitalist plan from a democratic socialist senator?
That’s a silly statement ―
In a cute way ―
No, no ― don’t, this is not a cute issue. We’re not playing games here. We’re trying to provide health care to all people. If your question is, is this the British program? No, it’s not. This is a program, like the Canadian program, which allows for a government insurance company, which simplifies the entire system, saves hundreds of billions of dollars, and provides health care for all people.
I didn’t mean in it in a ―
Let’s not play games. This is a serious issue and we’re trying to transform the United States and provide health care to all people. This will be obviously the most profound change in health care delivery in the history of the country. That’s pretty good.
The point that I would reiterate is that we are delighted to have 15 co-sponsors. It is more than we thought that we would have, to be honest with you. And I think that is an understanding on the part of members of the United States Senate that the world is changing and that more and more Americans wanna move in this direction and they’re responding, correctly so, to that movement.
And the question that we now face as a nation is, are we going to finally take on the greed of the insurance companies and the drug companies and Wall Street, and to do what is not radical and that is to provide health care to every person in this country as a right, which every major country does in whatever way?
You alluded to this, but, in a way ― when I look back to what happened during Obamacare and the way that the right-wing and corporate media was able to distort what was going on there ...
… it feels like there is a different paradigm, even in the minds of people in more conservative areas in the country. Is that because of the reach of Obamacare? What do you attribute that to?
Well, this is what I think ― and it’s a good question. What I think is that people have caught on to what the Republican ideology is about.
As I have said and as everybody knows, Obamacare has its problems: Too many people are uninsured, the deductibles, copayments, premiums are too high and the costs are going up. That’s a serious problem.
But the American people caught a glimpse, a strong glimpse of what the Republican ideology is about, when they said: “OK, Obamacare has problems. We’re gonna solve those problems by throwing 32 million people off of the health insurance they have.” And the American people said, overwhelmingly, “No, that’s not what you’re going to do.” In fact, that proposal was the least popular major piece of legislation introduced in the modern history of this country.
And so I think the American people are catching on to where the Republicans are coming from. They see the limitations of the Affordable Care Act, and they’re looking at the alternatives. And this is a rational alternative.
In a way, did having that threat emerge, and then be killed, did that help clarify things?
Yes, it did. I think it did.