180 million of us are satisfied with the private healthcare coverage we enjoy, but for the greater good we will be asked (forced) to allow the government to take over its administration. However, the inherent flaws of government with no incentives or accountability, have driven to bankruptcy every entitlement or service they run - Medicare, Medicaid, social security, the post office, etc.

Obamacare's estimated cost was a pittance compared to the projected cost of a total government takeover, but after five years a study found that its administrative costs "exploded". One of its authors, a proponent of single payer, said "This number… is shocking even to me. It's almost one out of every four dollars is just going for bureaucracy". Experience foretells Medicare for all (MFA) will be ruinous in economic and human cost.

MFA cost estimates from left and right private think tanks range from $2.4-$3.4 trillion per year. For perspective last year the federal government collected $3.64 trillion in taxes from all sources and the CBO projects collection of $46 trillion in total over the next decade indicating taxes will need to be increased 70% from today's levels. Sanders' massive tax increases on the successful to over a 50% top rate, will only cover half the needed revenue according to Leonard Burman former top CBO and Clinton tax official. Sanders is also proposing a new government healthcare "premium " (payroll tax) of 8.4% split 75% to employers and 25% to employees. MFA will still be underfunded. Just these new taxes alone will be economic crushing burdens.. Yes people won't be paying for private insurance any more, but while the left leaning Urban Institute projects potential savings for lower and middle income families and employers might amount to about half of the projected costs, the balance will come from " Higher income people who will likely face the greatest increases in taxes, meaning their new tax burdens will likely exceed their savings". A dissenting Emory University study by a former Clinton HHS assistant secretary projects that under single payer 70% of working privately insured households will pay more in new taxes than they will save in premiums. Fiscal critics of Obamacare said from the beginning that spending provisions would prove "durable and irreversible" but offsets without bipartisan support would fail. Gone are the Individual Mandate Tax, the Cadillac Tax, etc. . The loss of these punitive revenue streams, plus cost overruns, have obliterated the original ACA cost estimates. In 1965 when Medicare itself was created it was projected to cost $12 billion in 1990, the actual cost was $90 billion, adjusting for inflation they were still wrong by nearly 100%. Are we to bet it won't happen again?

In human cost all MFA plans have one critical element in their assumptions, cost savings. Currently Medicare rates average about 30 to 40% lower for doctors and hospitals respectively than those paid by private insurers. HHS projected in 2019 81% of hospitals lose money treating Medicare patients thus MFA would cause them to lose money on at least 81% of all patients. How long do you think that will go on especially in already underserved rural communities. What do you think will be the impact on the availability of doctors. Who will take on well over $200k of student loan debt facing government takeover of their (collapsing) potential income stream. Even without MFA the AAMC projected a shortfall of 50k-120k doctors by 2030. Another survey in 2016 by SERMO, the largest healthcare professional polling company, found that just 57% of doctors accepted obamacare patients, that's was down from 61% in 2015 and 76.5% in 2014. Add to this that 46% of US doctors are over 56 years old, and nearly half already won't accept government insured patient's, what will 100% government patients do to previously "near" retirement ranks. Everyone would have the ability to get healthcare on demand and they will have no skin in the game (copay, deductible, etc) to stop them, what will that do to overall wait times and accessibility. A Survey in 2017 showed that from 2014, when obamacare was finally fully ramped up, to 2017 new patient appointment wait times in our largest cities rose from 18 to 24 days, an all- time high. An interesting aside the worst wait for large cities in the country was Boston, 52.4 days, which enjoys a template for obamacare called Romneycare. Since we are talking about a democratic win to implement MFA, it would be shortsighted not to include 20 million plus "undocumented citizens" and open borders in considering the impact on our healthcare system's demands. The law of supply and demand can't be ignored. A diminishing supply of doctors and exploding demand for their services can only lead to rationing. When you truly need a doctor you need a doctor, now the government will decide who goes first or at all?

I'll close with the thoughts of the architect of Obamacare, Dr. Ezekiel Emanuel in his "Complete Lives System" published as "Principles for the Allocation of Scarce Medical Interventions" in the medical journal Lancet: "Such an approach accepts a two-tiered health system-some citizens will receive only basic services while others will receive both basic and some discretionary health services…. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed. An obvious example is not guaranteeing health services to patients with dementia." … "Strict youngest-first allocation directs scarce resources predominantly to infants. This approach seems incorrect. The death of a 20-year-old woman is intuitively worse than that of a 2-month-old girl….. "When implemented, the complete lives system produces a priority curve on which individuals aged between roughly 15 and 40 years get the most substantial chance, whereas the youngest and oldest people get chances that are attenuated." Is this the hoped for socialist solution we are all expected to embrace?