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For many Americans, the search for health care is less desperate, but the struggle to pay for it is very real. More people have insurance under Obamacare. But many don't, and others complain of the cost, which is why presidential candidate Bernie Sanders sparked a debate by promising Medicare for all. NPR's Alison Kodjak reports.
ALISON KODJAK, BYLINE: Health care for all - it's always a big applause line on the stump. And it delivered when Senator Bernie Sanders spoke recently at Eastern Michigan University.
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BERNIE SANDERS: I believe that the U.S. should do what every other major country on earth is doing, and that is guarantee health care to all people as a right.
KODJAK: Sanders basically wants to nationalize the U.S. health insurance industry. Any American could go to the doctor or fill a prescription, and Uncle Sam would foot the bill - get rid of co-pays, get rid of deductibles and get rid of lots of forms. And Sanders says he can pay for it by raising people's taxes by 2.2 percent and charging employers 6.2 percent of their payroll. Steffie Woolhandler is an MD and professor of public health at Hunter College of the City University of New York. She says the system will be more efficient without private insurers.
STEFFIE WOOLHANDLER: The medical insurance industry is really a group of middlemen. There's no need to have middlemen between paying for care and actually receiving care.
KODJAK: She says a health care system that covers everyone is clearly in the public interest.
WOOLHANDLER: Single-payer plans in other countries are affordable. They're running at 40 percent lower cost on a per-capita basis than what we spend in the United States.
KODJAK: But many liberal economists aren't buying - like Jared Bernstein, who was a top economic adviser to Vice President Joe Biden until 2011.
JARED BERNSTEIN: I like the goal of the plan. I'm not sure the numbers add up, but the aspirations add up.
KODJAK: Bernstein says Sanders is onto something when he says getting rid of insurers could help reduce what the United States spends on health care. Hundreds of billions each year goes to administrative costs, profits and marketing. But getting there would mean displacing a huge industry.
BERNSTEIN: The government would make public something like 8 or 9 percent of the economy that's currently private. That would be hugely disruptive to those on that private side.
KODJAK: Bernstein says such a plan could never pass Congress, so it's more realistic to work with the system we have.
BERNSTEIN: I would probably spend more time and energy as a progressive fighting to keep and improve the Affordable Care Act than I would fighting for single-payer.
KODJAK: Bernstein is one of the sympathetic voices. Many other Democrats have published scathing analyses and openly bashed Sanders' plan. Austan Goolsbee was chairman of President Obama's Council of Economic Advisers. He says Sanders overestimates the savings and underestimates the tax increases. And he says people should be a little more skeptical.
AUSTAN GOOLSBEE: If you promise, I'm going to take you to the finest French restaurant and give you chateaubriand and it's only going to cost you $2.79 cents, it's right to be a little skeptical and say, how do I know you're not just going to give me a Wendy's spicy chicken wrap and call it a day?
KODJAK: Goolsbee is one of four leading Democratic economists who've written an open letter to Senators calling his economic assumptions extreme. The group says Sanders' promises undermine the credibility of the Democratic Party. The skeptics are also a little weary of fighting over health care.
GOOLSBEE: I was there when we were doing Obamacare. And that was a really hard job. The thought of refighting that battle does make me nervous.
KODJAK: The Sanders campaign clearly knows this and says critics are just establishment voices that don't want to disrupt the status quo. Alison Kodjak, NPR News, Washington.
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