A true single-payer health care system would mean the discontinuation of employer-sponsored health insurance. Vermont Senator Bernie Sanders’ new single-payer proposal proceeds along these lines, making it unlawful for employers to duplicate the offerings of the new single-payer system once that system is fully phased in. However, a truly single-payer framework is not the only approach policymakers could take.

Dr. Tevi Troy, author of the paper and CEO of the American Health Policy Institute, says, “The federal government would be taking on the responsibility of providing health care to all Americans, a change so drastic with consequences ultimately so uncertain that it seems unlikely to win a majority of votes in Congress, especially considering how politically unfeasible it has proven on a much smaller scale even in very liberal states like Vermont.”

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While some progressives campaigned this week for “Medicare for all,” a group of moderate House Democrats aligned themselves with a more modest push to stabilize the ACA, arguing that it could spur broader health care reforms in the future. Thirty-five of the 61 members of the New Democrat Coalition sent a letter Friday urging the leaders of the Senate Health, Education, Labor and Pensions Committee to agree on a bipartisan bill to keep premiums from rising further for Obamacare enrollees next year.

On Wednesday, Sen. Bernie Sanders introduced a single-payer health care bill that would create a national health insurance program, charting a stem-to-stern reshaping of the country’s health care system. The bill would make it so that Americans would get health coverage simply by showing a new government-issued card and would no longer owe out-of-pocket expenses like deductibles. But Sanders’ description of his measure omitted specifics about how much it would cost and final decisions about how he would pay for it.

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The Democratic Party now is, for all intents and purposes, the party of single-payer health insurance.

Big mistake.

Democrats are committing themselves to years more of treacherous health care debate, at a time when there are more pressing issues to confront. They are emulating Donald Trump’s penchant for quick-fix, bumper-sticker solutions that prove to be, in his own words, more “complicated” once in power. And instead of maintaining a candid relationship with its ideological base in order to temper expectations, the party establishment is indulging it, risking bitter disappointment in the future.

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If Bernie Sanders wants to follow Medicare as his model, then the Sanders plan could easily earn another moniker: Benefits for Billionaires. An analysis released by the Congressional Budget Office in August demonstrates how Medicare currently provides significant financial benefits to seniors at all income levels, including the wealthy. The CBO found that at every income level, seniors received more in Medicare benefits than they paid in Medicare taxes. Men in the highest income quintile—the top 20% of income—received a net lifetime benefit from Medicare of nearly $50,000, even after taking into account the Medicare taxes and premiums they paid.

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As ObamaCare continues to collapse, options for quality, affordable health care move further out of reach for many Americans. This week, Senator Bernie Sanders, D-Vt., and other Senate Democrats plan to offer their solution: a complete Washington takeover of America’s health care system.

A majority of Democrats in the U.S. House of Representatives have signed on as co-sponsors of their own “single-payer” legislation. This idea is good for whipping up the far-left base – and bad for everyone else. It will deliver worse care, inevitably leading to rationing. It also will be outrageously expensive for everyone.

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“Single-payer” is a broadly popular slogan that papers over intraparty disagreements and wrenching policy choices. A recent survey by Kaiser found that initial support for single-payer dropped by about a third when supporters were told of criticisms that it might increase their taxes, give the government “too much control” over health care or eliminate the ACA. Each of those critiques would probably be made prominently by Republican opponents of the policy.

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This brief describes alternative forms of subsidized reinsurance and the mechanisms by which they spread risk and reduce premiums. For a given amount of funding, a particular program’s efficacy will depend on how it affects insurers’ risk and the risk margins built into premiums, incentives for selecting or avoiding risks, incentives for coordinating and managing care, and the costs and complexity of administration. These effects warrant careful consideration by policymakers as they consider measures to achieve stability in the individual market in the long term.

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How do you define “single payer”? A common theme is to give government a dominant role in the pricing and possibly delivery of services—supporters often assert that some measure of cost would be reduced. The Urban Institute’s Health Policy Center says that Bernie Sanders’ previous proposal in 2016 would have increased federal costs by $32 trillion over the next decade. Even Democrats would have a hard time getting support for this unprecedented expansion of federal spending. In spite of the superficial allure of Medicare for all, Democrats are not eager to upend the health system that President Obama created.

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A recent poll demonstrates the strong bipartisan support for quick action to protect coverage choices and affordability. According to the poll conducted in August, 76% of all registered voters support bipartisan legislation to help make insurance markets more stable, to ensure coverage choices and to keep premiums in check; this includes 78% of Democrats, 73% of independent and 76% of Republicans.

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