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Bernie Sanders explains why he thinks everything short of Medicare-for-all is failure

Sen. Bernie Sanders (I-VT) is releasing a new plan to give every single American free health insurance.

And he’s ready to defend it.

On Wednesday, Sanders will release a single-payer health care bill that about one-third of Senate Democrats have already vowed to support. Historically, Hillary Clinton and most Senate Democrats have opposed advancing single-payer health care, and Sanders found zero supporters for the same version of the bill when he introduced it in 2014.

“We had me. And that was it,” Sanders told me in an interview in his Senate office on Tuesday after the 11th Senate Democrat publicly backed his bill.

But now 15 Senate Democrats — many of whom are potential 2020 contenders — have signed on to the bill, even though it hasn’t yet been publicly released. Sanders’s new “Medicare-for-all” bill, the product of months of debate and negotiations, may be the most detailed single-payer legislation introduced in Congress.

The bill’s newfound popularity will surely come with scrutiny, and in our interview Sanders acknowledged the difficulty of the policy trade-offs in crafting the bill.

“This is complicated stuff. And you know what? There’s nobody who has all of the answers. Nobody has all the answers,” he said.

For all the wonky policy objections raised against his single-payer plan, Sanders returns to what he regards as the fundamental reason animating his renewed Medicare-for-all legislation: 28 million Americans still lack health insurance, and about 30 percent still say they face personal crises over medical debt and making insurance payments.

“Millions of Americans today — who do not go to the doctor when they should, because they can't afford the health care bill — many of them will get sicker than they should have been. And some of them will die,” Sanders said.

“What this struggle is about really, honestly, is not a health care debate. Should health care be guaranteed to all people? Most people say yes. Are we wasting an enormous amount of money in the current system? Most people would say yes. Can we take on the drug companies and the insurance companies and Wall Street and their unlimited sums of money to influence Congress? ... That's a major political struggle that we have to engage in.”

Sanders and I delved into the policy mechanics of his bill. We also discussed whether he’ll attack Democrats who won’t support his bill (no), whether he’ll tell his supporters to stand down (also no), and how he explains Democrats’ sudden interest in single-payer.

A lightly edited transcript of our interview follows. Vox’s Kelly Swanson helped prepare the transcript.

The crisis in the American health care system that Bernie’s bill is trying to solve

Bernie Sanders in his Dirksen Senate Office with Vox reporter Jeff Stein.
Bella Lucy/Vox

Jeff Stein

So I want to start out by talking about the current gaps and crises in the American health care system. Twenty-eight million Americans are still uninsured. Upward of 30 percent still struggle to pay [their] medical bills.

I want to ask: What is the major crisis this bill addresses, and how, specifically, are you going to address [it]?

Bernie Sanders

Here is the crisis: 28 million, as you've indicated, have zero health insurance. Even more are underinsured, with high deductibles and high copayments, and the projection is that health care costs are going to continue to rise.

What that means in practical terms is there are millions of Americans today who do not go to the doctor when they should, because they can't afford the health care bill. Many of them will get sicker than they should have been. And some of them will die. That's just the sad fact.

So the question that we have got to ask ourselves is: Should health care in the year 2017 in the United States of America be a right of all people? Or is it just the privilege of wealth? In other words, if you got the money, you can go out and get pretty great health care. [If] I don't have the money, well, I don't get that health care.

Or should we join the rest of the industrialized world and say that it doesn't matter whether you're rich or poor, young or old, healthy or sick — health care is a right. Every other major country on Earth has decided that health care is a right, and we've got to do the same. That's No. 1.

No. 2: a very important question, which is virtually not discussed by the media or discussed here in Congress, and that is why is it that despite all those without any health insurance or who are underinsured, we end up spending almost twice as much per capita per person on health care as the people of any other nation?

Why is it in Canada they spend less than $5,000 per person and guarantee health care to all of their people? We spend almost $10,000, and we have so many people uninsured or underinsured.

Thirdly, why are we paying the highest prices in the world for prescription drugs, so that one out of five Americans under 64 cannot afford the medicine that they need? Those are the questions that in fact we do answer in our legislation.

Sanders on ending private health insurance and “legitimate concerns” around single-payer

Medicare Security To Be Reviewed After Patient Details Sold On Darknet Photo by Michael Dodge/Getty Images

Jeff Stein

One hundred and fifty million people currently rely on their employer-sponsored health care plans for insurance. And I'm curious why you think eliminating that is an essential foundation of universal health care. Some Senate Democrats say we can achieve universal health care without eliminating [private markets].

Bernie Sanders

Well, you can, but you can't save the kinds of money that we have to save and create the kind of system that I think we need.

So here are the reasons [for] a rational health care system, if we were sitting down and saying, “Okay, what is our goal? What does a rational health care system look like?” And what it looks like is saying everybody is in.

We're going to guarantee health care to all people. And it's a pretty expensive proposition, providing health care to all people, of course. Health care is expensive. How do we do it in the most cost-effective way? And the most cost-effective way is not allowing insurance companies and drug companies to make hundreds of billions of dollars a year in profits from human illness.

It is also not creating an incredibly complicated system. We have hundreds of different insurance programs in this country that have to be administered at great cost. Right? So you have a $5,000 deductible; I have a $3,000 deductible; he has a $50 copayment. You can’t go to that doctor, but she can go to that doctor. It's an incredibly complicated system, and we are wasting hundreds of billions of dollars administering this incredibly complicated system. ... You’re having doctors who have been increasingly demoralized, nurses demoralized because they can't even provide the health care they need or they want for their patients, because the drug companies and insurance companies are interfering in the delivery of that health care. That's one important issue.

And there's another one from an economic point of view, and that is, right now — you're right, of course — most Americans get their health care from their employers.

Go and talk to employers — especially small businesses — and find out how much time and energy they are wasting trying to provide health insurance to their employees.

Their job is to make widgets, or to provide services or do whatever they're supposed to be doing. And yet they're spending a lot of time and energy providing health care to their employees, which they would prefer to spend focusing on their business mission.

Then you also talk to people who say, “You know, I really don't like my job, [I] really hate my job, but I go to my job because my wife is ill and I have to make sure that I have good coverage to take care of her.” Is that a way to run an economy? So there are a lot of reasons why I think we need to do what virtually every other country has done, and get private insurance companies out of the essential health care.

Jeff Stein

Sixty-one percent of Americans said that they're satisfied with their current health insurance plans. How does this bill — or how do you — plan on reassuring them that the care this bill would provide is either better [than] or comparable to what they currently have and like?

And as a second, corollary question: Do you worry about the political impact of telling all of these people, “Hey, you're going to have to switch plans”? President Obama got a huge backlash over saying —

Bernie Sanders

It’s not a question of switching plans.

Look, the real question to be asked, or one of the questions I ask, is why is it that we're spending so much compared to other countries? Why [do] we have so many people uninsured? What's the answer to that? And the answer is that is not too many people go around defending the health care system. ... [But] the drug companies since 1998 have spent over $3 billion in lobbying and hundreds of billions of dollars in campaign contributions, and the insurance companies are No. 2.

In other words, what this struggle is about really, honestly, is not a health care debate. Should health care be guaranteed to all people? Most people say yes. Are we wasting an enormous amount of money in the current system? Most people would say yes. Can we take on the drug companies and the insurance companies and Wall Street and their unlimited sums of money to influence Congress? That is another issue, and that's a major political struggle that we have to engage in.

But in terms of answering your question — you know one of the lies that will be thrown out at us is that “this [is] government health care; you're gonna have to go to a government doctor.” Total nonsense. You go to the same doctor. You go to any damn doctor you want to go to. What's going to change is the wording on the card that you have. It will no longer be United Health Insurance or Blue Cross Blue Shield. It'll be Medicare-for-all.

You go to the doctor you want who will still be practicing in exactly the same way he or she practices today. Go to the same hospital. So don't let anyone tell you that suddenly this is going to be government-run health care and every health care worker in America or every doctor is going to be a government employee. Not the case.

Sanders’s “pledge:” middle-class families will pay less in combined taxes and health care

Senate Lawmakers Address The Media After Their Weekly Policy Luncheons

Jeff Stein

So on the question of financing, there was a lot of talk during the campaign that your bill didn't have specified pay-fors — or, insofar, as there were financing plans drawn up by health economists and experts, that there was this concern that some middle-class families would see tax hikes in the end.

Another concern is that the savings from not having to pay for insurance would not be greater than those tax hikes. How do you ensure that —

Bernie Sanders

Let me be very honest. We’re dealing with one-sixth of the American economy. This is complicated stuff.

And you know what? There’s nobody who has all of the answers. Nobody has all the answers. What I can say is we are going to be listing a number of revenue-raising proposals, which will generate more than enough money to pay for what we want to do.

But here is the point. And I have to say, rather amazingly, how many of my political opponents were people who disagree with me on this issue — mostly Republicans and the media forget about it. Right now, if you are a family of four and you're self-employed, for example, you might go out and be spending $10,000 to $18,000 a year for private health insurance. Right? We’re going to eliminate that.

And, yes, your taxes are going up. But if you are a middle-class person, you will be paying less overall for health care and taxes than you are paying today. That's what our pledge is. Yes, you'll be paying more in taxes, but you'll be paying less — zero — in private insurance. So I think what Republicans will go around saying, “They’re raising your taxes.” They will forget that 30 seconds [in an ad that] I have to tell you you're no longer paying private insurance if you're a small business. You're no longer having to provide insurance to your employees. So there are two sides of the equation.

Jeff Stein

One concern I've heard — and I'm curious for your reaction to — is a lot of union representatives have health care deals that have taken brutal toil and sweat to win, to force their employers to give them these agreements for health care benefits.

All of a sudden they're getting hit with a tax increase from this bill, while also maybe losing the benefits they had to negotiate for. How do you assure those folks?

Bernie Sanders

I understand that. And that's a legitimate concern.

What you're saying is that over the years, an employer may say, “You’re going to get a raise or a wage increase, or we’re going to maintain or not hurt you so much in terms of health.” I do understand that concern.

I think what we can also say [is] that right now if you look at a lot of the labor disputes that go on, very often they have to do with health care. They have to do with employers saying, hey, you know what, we're raising deductibles, raise your copayments. And sometimes we are seeing strikes just around those issues.

So I think what we can say to those workers is they will be better off financially and that their business that they work for will be better off financially. One of the things we don't talk about is that American companies today have got to compete in a global economy in which in most instances, but not all, their competition does not have to worry about providing health insurance to their workers because their governments do that.

Jeff Stein

So just to stay on this point for one more second, how do you ensure workers that their bosses won’t just pocket this? How do you make sure?

Bernie Sanders

I mean, this is a big issue, and we are introducing comprehensive legislation at a time when we have Donald Trump as president, who wanted to throw 32 million people off the health insurance. You know, Mitch McConnell, Paul Ryan, running the Senate and the House. We're not going to get this thing done with these guys in power.

And what we are doing is taking an idea out to the American people, and you're going to see a lot of discussion about these ideas and [a] lot of refinement of what we are talking about. But I think that any serious discussion of where we are today, in terms of the dysfunctionality of the system, in terms of the cost of this system, will suggest that going forward will be a significant improvement.

Jeff Stein

One thing I thought was really interesting in the summary of the bill we got is if you look at the last title, it calls for doing this by dropping the Medicare eligibility age every few years. The [John] Conyers bill does that overnight — in closer to two years, everyone is insured.

This would do that in three or four steps. Could you talk about the trade-offs there and how you came up with this plan?

Bernie Sanders

I wish that I could say that — you know, maybe ... somebody could make the argument that tomorrow, or in a given day six months from now, we can put everybody into one program. And I'm not sure that's not correct.

But what we want to do — there are people who are concerned about the transition process. This is the big deal. So what we have said is that in the first year we are going to improve Medicare for the elderly by providing dental care and audiology treatment, which is not currently the case. And what we're also going to do is lower the eligibility age from 65 to 55, and we're going to cover all children under 18. That’s a pretty big deal.

So the system's going to have to digest that idea, and then we're going to go from 55 down to 45, 45 down to 35 [and so on]. So it gives the system the time to adjust.

Sanders won’t attack Senate Democrats who are against the bill, but he won’t tell his supporters to stand down

Bernie Sanders Campaigns In East Los Angeles Photo by David McNew/Getty Images

Jeff Stein

Why are more Senate Democrats supporting this now? Often, you hear about when a party loses the election, it tries to move to the center. Democrats’ ambitions and dreams are growing, and the Democratic establishment is opening up to this idea.

Why do you think that is happening? And then as a follow-up: How do you think your supporters should respond to or treat Senate Democrats who were reluctant to get on this or haven’t? Should it be a matter of pressuring them, campaigns, sit-ins?

Bernie Sanders

I’ll answer both the questions. I will tell you that three years ago — when we introduced this legislation four years ago — we had me, and that was it. So the sentiment, not only here in Congress but, I think, among the American people is moving in our direction.

Here's where we are politically. President Obama led the way to passage of the Affordable Care Act. In my view, the Affordable Care Act has made some very significant improvements in American health care. You know, we kind of brush it off. But 20 million more people are now insured than was previously the case. It may not seem like a big deal here on Capitol Hill. Everybody has insurance. That's a pretty significant improvement if you're in a state like West Virginia and Kentucky and you get health insurance. Second of all, and again, we brush it off now, but we did away with obscenities like preexisting conditions. There are other very positive attributes associated with the Affordable Care Act.

But having said that, what everybody recognizes is that the health care system, despite the gains in the ACA, has serious problems, and they are growing costs, high deductibles, high copayments, 28 million people uninsured, lack of freedom of choice regarding the doctor you go to, burdens on employers, burdens on workers.

Then the Republicans said, “There are problems with the system, and our solution is to throw 23 million people off of health insurance and give tax breaks to the rich.” Most Americans thought that was a pretty stupid idea. You don't improve the system by throwing 23 million people off health insurance.

We are where we are today: We have seen gains in the ACA, but many serious problems remain. And I think the American people are looking for answers on what you're seeing at the grassroots level and what you're seeing in polling, as more and more people say, “You know what? The United States government should take responsibility for making sure that people have health care.” So that's why I think we are where we are.

Your second question is a very political question. Am I going to go around and attack people who do not support my proposal? I don't do that, and I'm not going to do that. You know [there are] a lot of different issues out there, and people disagree with me. People have to make their own assessments, and the electorate decides the course of action in terms of elections. But I'm not going to be criticizing people.

Jeff Stein

Would you urge your supporters not to?

Bernie Sanders

Well, it's a question. Look, I happen to believe in democracy, and people will do what they will do.

We are going to be mounting a massive grassroots effort across this country to educate and to organize. That's what we will do. We're going to have to take on Wall Street, the drug companies, the insurance companies, the corporate media. We're going to have to explain what a Medicare-for-all, single-payer system means.

So it's going to take a lot of work — and that's what we intend to do.

Jeff Stein

Do you worry about Senate Democrats being put in a tough spot? If [Montana Sen.] John Tester wants to win over the Bernie voters in Montana — I believe a state you won — without being a co-sponsor, he appears to feel like he’s signing on to a political risk?

Bernie Sanders

The people who run for United States Senate who are in the United States Senate are very big boys and big girls —they have to deal with many, many issues and many problems.

Many of my Democratic colleagues have had to sustain zillions of dollars of dishonest Republican 30-second ads. They will make the case that they can to their constituencies. You know what? That's called democracy. You know, I respect [that]. People have different points of view [and can] make their case.

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