Beyond the lower payments, the researchers also suggest hospitals would spend less money on overhead, having to navigate only a single insurance plan. That change accounts for $219 billion in their estimated savings.
But again, that ignores some of the reality of how hospitals work. While a single-payer system would undoubtedly cost less to administer — requiring a smaller back-end staff, for instance — it would not eliminate the need for expensive items like electronic health records, which coordinate care between hospitals.
“The assumptions are unrealistic,” said Gerard Anderson, a health economist at Johns Hopkins University in Baltimore. “You are never going to save that much money from the various providers.”
The Cost-Sharing Question
Medicare for All would enroll all Americans in coverage far more generous than what most experience now — eliminating virtually all cost sharing associated with using health care.
That’s a major change, researchers told us. Previous evidence suggests that such a shift would encourage consumers to use health care more than they currently do.
The Lancet paper acknowledges that — but only partially. It allows that people who are uninsured or “underinsured” — that is, who have particularly high levels of cost sharing now — would use more medical care under Sanders’ system than they currently do. It factors that into the price tag.
But its estimate does not account for people who already have decent or adequate insurance and who would still be moving to a richer benefit, and therefore be more likely to use their insurance.
“It drastically underestimates the utilization increases we would expect to see under Medicare for All,” McIntyre said. “People have different views on whether the increased utilization is good or bad,” she added — it makes the program more expensive, but also means more people are getting treatment.
Context is helpful, too. Other estimates — namely, a projection by the Urban Institute — of Medicare for All have suggested it would increase federal health spending by about $34 trillion over 10 years. But the elimination of other health spending would make the overall change smaller.
To implement the Sanders proposal, national health spending — public and private dollars, both — would increase by $7 trillion over a decade, Urban said. And Medicare for All would be bringing new services: more insurance for more people, and more generous coverage for those already covered.
Urban’s estimate of $7 trillion more in spending over 10 years is far removed from the study’s estimate of $450 billion less annually. And, experts said, relying on the latter figure isn’t a good idea.
“I think they need more work to prove” the savings, Meara said. “They’re not being complete, and by not being complete, they’re not being honest.”
It’s also worth noting that the study’s lead author was also an informal unpaid adviser to the Sanders staff in drafting its 2019 version of the Medicare for All bill, according to the paper’s disclosures section.
The ‘Lives Saved’
Experts agree that expanding access to health insurance would probably reduce early mortality. But the 68,000 figure is another example of cherry-picking, Meara said.
The figure is based on a 2009 paper. It doesn’t acknowledge a body of research that came afterward, including multiple studies that examined how expanding Medicaid affected mortality — and maybe offered less dramatic numbers.
“When they so clearly are cherry-picking, when they clearly have all the information on studies in front of them, it’s concerning,” Meara said. “It’s a situation where you’re going to overpromise and underdeliver.”
Sanders said a recent study suggested Medicare for All would save $450 billion annually and save 68,000 lives.
That study does exist. And it cites some evidence. But many of its assumptions are flawed, and experts uniformly told us it overestimates the potential savings. It cherry-picks data in calculating mortality effects.
This statement has some truth but ignores context that would create a dramatically different impression. We rate it Mostly False.