A Gold 'TrumpCare' Card Can't Hide the Bill: The Facts on Medicare for All

Michigan Sen.-elect Abdul El-Sayed has found a clever new way to sell an old idea. Newsweek reported that the physician, who won his race on a Medicare for All platform, posted a mock gold "TrumpCare" card urging President Trump to get behind a government-run health system. The Daily Mail reported that the pitch quickly went viral.

The message is aimed at working families worn down by premiums, deductibles and surprise bills, and those frustrations are real. Our readers feel them at the kitchen table every month. But a clever graphic is not a plan to pay for anything, and an honest debate about health care has to start with the bill.

The most widely cited analysis of Sen. Bernie Sanders' Medicare for All bill came from economist Charles Blahous at George Mason University's Mercatus Center. He estimated the plan would add roughly $32.6 trillion in federal spending over its first decade, and found that even doubling all projected federal individual and corporate income tax collections would not be enough to cover it. As the idea returns after the midterms, analysts are again pointing to trillions of dollars in new federal spending, according to a report carried by WJLA.

Supporters answer that Americans already spend that money through premiums and out-of-pocket costs, and that a single payer would squeeze out overhead and force down prices. Some savings are possible on paper. But moving nearly the entire health care bill onto Washington's ledger means the money has to come from somewhere, and that somewhere is the paychecks of the same families now paying premiums, collected by a federal government already carrying record debt.

It also means ending the coverage most working Americans have. The bill Blahous studied would replace private and employer plans with a single government plan. Families who like the insurance they earned at work would lose it, whether they wanted to or not, and would trade a choice of plans for a single program run from Washington and funded at the mercy of each year's budget fights.

We do not have to guess how single payer fares when real budgets meet real voters. Vermont, one of the most progressive states in the country, passed a law in 2011 aiming for a single-payer system. In December 2014, Democratic Gov. Peter Shumlin abandoned it after his administration's own numbers showed it would require an 11.5 percent payroll tax on employers and income-based premiums of up to 9.5 percent on residents. Shumlin called the retreat "the greatest disappointment of my political life".

If a small state with a Democratic governor, a Democratic legislature and years of planning could not make the math work, Americans have every reason to doubt that Washington can do it for a nation of 340 million. Vermont's leaders did not abandon their dream because of talking points. They abandoned it because the taxes required to fund it would have hurt the very workers and small businesses it was meant to help.

Conservatives agree the system needs fixing. The better path keeps patients, not bureaucrats, in charge: real price transparency so families can see what care costs before they buy it, more competition among insurers and hospitals, health savings accounts that let families keep what they save, and lower drug prices through tougher bargaining and more medicine made in America. Those reforms lower costs without forcing anyone off a plan they chose.

El-Sayed will take his oath in January as part of a new Democratic Senate majority, and the push for single payer will follow him into the chamber. Any Medicare for All bill would still need to pass both houses of Congress and win the signature of a President who has long opposed government-run health care. Republicans in Congress are ready to make the cost case at every step, and they will have Vermont's experience on their side.

The gold card makes for a good post. But patients do not need a novelty card. They need lower bills, more choices and a system that answers to them. Medicare for All, by its own supporters' arithmetic, offers none of the three without a tax bill few families could afford.