To hear Pramilla Jayapal tell it, budgets don’t matter and access to care is the same as quality of care.  Neither could be further from the truth.  Budgets do matter and access to care is not the same as quality of care.  But, as House Democrats gear up to push for Medicare-For-All these details hardly seem to matter to the majority party.  They should.

Jayapal is Co-Chair of the Congressional Progressive Caucus and it recently unveiled the most sweeping government take-over of healthcare in history.  Believe me when I say it is a takeover of healthcare.

The bill calls for a transition of the entire private market healthcare system to a government run system in a year.  Not even Bernie Sander’s $32 trillion boondoggle calls for such an quick transition.  Additionally, whereas some government-run healthcare markets, closest to home Canada, and European counterparts like Germany.

One of the arguments for why there would be no tiered market under the Caucus’s plans is it would create an uneven field of care.  The rich would get the same care as the poor, the young the same as the old, etc.  Additionally, there would be no co-pays for anybody (including those hated billionaires).  It is a sound byte and little more.

The political challenges this poses for the party are enormous.  More than half of Americans get their insurance through their employer (ie. private markets) and they report they are generally happy with the care.  Additionally, the reasons why even the most centralized government healthcare models allow for private care is because they want to still allow choice and if you have the money you should be able to choose.

Budget-wise, it is clear no analysis has been done on the cost.  The amount of new personnel needed to administer such a new system, the number of new departments and programs would be massive.  If you thought Bernie Sander’s plan was expensive just wait until this bill sees the light of day.

America’s healthcare system, where doctors can largely determine their rates, already has a shortage of physicians and specialists.  Let me say that again.  In a system where doctors can make six figures fairly easy there are still not enough doctors.  Now, imagine where a government run system are costs are highly regulated and doctors and hospitals lose any ability to negotiate their reimbursement?

This could particularly impact small, local hospitals.  The Affordable Care Act was supposed to incentivize small local hospitals and clinics to stay open.  Instead, it drove many of the doctors practicing in these areas to consolidate in larger hospitals with more clout.  As the ACA was largely a giveaway to big insurance companies, the larger hospitals won.  Doctors, like anybody else, will act rationally and migrate to employers who have the ability to get them a better deal.

For decades Canada had a somewhat similar system.  But, due to demand, the Canadian Supreme Court allowed for a private market to be created.  Likely, if this bill ever passed, the United States Supreme Court would allow the same.  Nothing says you cannot spend your money how you see fit.  Nothing in the Constitution mandates a one-size-fits-all policy.

From a politically practical standpoint, this bill will go nowhere this year.  In fact, it would probably go nowhere with a Democrat in the White and a Democratic Congress.  But, Republicans are sure to throw it out to voters as a sign of what to expect if they give the minority party the keys to power.  Democrats used healthcare to deadly effect last Fall.  Republicans are sure to do the same here and try to woo back some of the well-off, suburban voters they lost in November.