I didn't say better, I said a wash. Here's the thing: yes, the ramp-up and long-term administration will be costly, and that's what Sanders' financial transaction tax and marginal rate increases for top tax brackets are for. If you look at Sanders' plan, taxes for anyone but those in the highest bracket are essentially flat. But, you also remove spending on private insurance for individuals and employers. So the effect is that, yes, the wealthy will probably be paying more than they do now, but for the rest of us, costs will go down. Significantly.
This isn't true. As I said earlier, you're assuming that private insurance isn't already at scale. Further, you're assuming that the government can beat a private company in terms of cost efficiency and I'd blindly assert that doesn't ever happen. I'd be willing to put money on private insurers having a lower overall cost profile. The data on private insurers shows there is not much waste in the private system, so you can assume that the costs paid by workers and businesses today will increase in a government run system. The amount of increase may be debatable, but it isn't debatable whether it will increase. In terms of the taxes only being increased on the top marginal brackets, this is also untrue. Under the Sanders plan, the bottom tax bracket receives a 2.2% increase which affects EVERYONE, while his suggested new top bracket receives a 15% increase. All brackets are adjusted up under Sanders plan and that's before we even talk about payroll taxes. Sanders payroll tax alterations are expected to result in a 4.3% reduction in income for wage earners. Overall his medicare and tax retrofit would cost the US economy dearly. Estimates from the Tax Foundation come in at 6 million jobs lost, 4.3% reduction in income for wage earners, US GDP loss of 10% (yes, 10%, that's catastrophe), and the tag on effects for capital investment are estimated between 15 and 20%. I think it's woefully ignorant when people say "The Job creators will pack up and leave" I don't think it is ignorant to hold that they won't be looking to expand in a drastically altered tax regime.
but for the rest of us, costs will go down. Significantly.
And income will drop by a greater amount, assuming you don't lose your job.
People who don't have an income won't pay taxes, and therefore will not have to pay for health care, simple as that.
That is already the case today.
People who can't afford insurance don't get primary/preventative care.
True, but giving them medicaid won't change that. This is especially true if there is a capacity problem due to lagging payments. Providers are already dropping medicare due to the reimbursement problems. This would get worse with more people on medicare.
They cost the system more in the long run due to what I described above. They come in for catastrophic care, which costs more than preventative care. They can't pay for it when all is said and done, so then you need hospitals, insurance companies and charities to pick up the slack, which is also inefficient and costly.
Medicare for all doesn't change this paradigm.
But, I guess I should be more precise. Some minimum standard of guaranteed care, that, among other things, includes one primary care visit per year, should be a right.
And that has already been attained under the ACA.