According to the New York Times, “left leaning economists” say Sanders can’t pay for his proposed programs. (For an alternative viewpoint, see BillMoyers.com which says the NYT irresponsibly cherry-picked experts with ties to the Obama/Clinton administration).

Mr. Sanders’s plan includes a new, across-the-board 2.2 percent income tax to help pay for his single-payer, government-run health plan for all. But progressive economists and business groups say middle-class taxpayers would pay more for the European-style social welfare state that Mr. Sanders envisions.

They dispute his contention that all but the richest Americans would be better off, on balance, with higher wages and benefits like expanded Social Security, free public colleges and, most of all, free health care. His policy director, Warren Gunnels, dismissed the critics in an interview, saying, “They’ve picked sides with Hillary Clinton.” The campaign has a list of 130 endorsees, including some economists.

“If, at the end of the day, people don’t believe that we can achieve the same savings as Canada, Britain, France, Japan, South Korea, Australia are achieving on health care, then we have a fundamental disagreement,” Mr. Gunnels said, naming countries with single-payer systems.

There’s that cynicism again. It works everywhere else but it can’t work here because…why exactly? Because we choose to be cynical, for one. And because we let the medical and insurance industry buy politicians and write laws in its favor and at everyone else’s expense.

I will say, though, that I am attracted to the idea of a well-functioning market setting prices rather than the government setting them. We live in a world of finite resources, so if you truly have no price signal – no premiums, no co-pays, no bills of any kind – then people can’t be allowed to choose any amount of health care they want, because our collective wants will always exceed what we can collectively afford. Then you have to have government rationing and price controls. That is what single-payer is. It is an efficient system to deliver some amount of health care the experts think is affordable and cost-effective. It’s equitable because it can deliver the same rationed amount to everyone, rich or poor. It is not a market-based system.

What could a hypothetical pure market-based system look like? First, the U.S. political system would have to not depend on contributions from the medical, insurance, and finance industries, so politicians would have no incentive to favor the profits of these companies over the interests of voters. Then people would have the option, or perhaps the requirement, to save a portion of their incomes in a health savings account. Then they would use their own money to purchase health care. Government would make copious amounts of education and information available on what medical services are available and how much they cost and what outcomes are being achieved, in terms simple enough for anyone to understand, so that true apples-to-apples comparison shopping would be possible for anyone, even under the stress of serious or sudden illness. Prices would settle at a level where supply and demand are in harmony given what the society can afford in aggregate and what other goods and services people are willing to give up in exchange for health care. Companies would have to compete based on price and outcome, and would have to innovate over time or else lose their edge.

The above might be an economist’s utopia, but it would not be remotely equitable, because the rich could afford much more than the poor. Government could do a few things to help. The savings accounts could be tax-advantaged, obviously. The savings could be matched by government, and the match could be larger for the poor and gradually phased out for the rich. Basic preventive care and maintenance care for chronic conditions could be provided for free (i.e. by taxes), because we know that is cost-effective. Catastrophic insurance could be provided for the big expenses, because we know those are back-breaking for all but the super rich, and when the poor show up in emergency rooms we end up treating them (poorly) at enormous taxpayer expense. With these policies in place, people are now using their savings only to make those decisions in between preventive and catastrophic, the things you could argue they want but don’t necessarily need. The rich would still be able to afford more, but hey, that is the nature of a market economy unless you want a true socialist utopia. I assume we still want some incentive to work or start a business.