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WATCH: Health Care Candidate Bernie Sanders Doesn’t Appear to Know What a Deductible Is

Independent Vermont Senator and Democratic presidential candidate Bernie Sanders has staked much of his candidacy on his “Medicare for All” plan, but does not appear to know the basic mechanics of health insurance, such as what a deductible is.

Democratic candidates who are campaigning on Medicare for All — especially Massachusetts Elizabeth Warren, but also California Senator Kamala Harris — should study the huge red flags in Sanders’ performance at a health care town hall in Florence, South Carolina this weekend, as the senator struggled to answer questions about his plan even from a friendly audience.

One man told Sanders that his employer pays 85 percent of his premium, and said “When that gets shifted into a tax on the individual, it seems like that’s going to be good for the employer, but it’s going to end up putting a bigger portion on me. I’m not sure I’m going to come out better on it.”

“I think you will,” Sanders said, “And I’ll tell you why. You’re not going to pay, right now your employer is paying 85%, you’re paying 15%.”

“Do you have any deductibles in your plan?” Sanders asked, and when the man told him it was $500, the senator asked “Per what? Per month, or per year, or what?”

Health insurance deductibles are per year, a thing that a candidate basing most of his candidacy on health care ought to know.

Sanders then delivered the now-familiar answer that the savings on out-of-pocket expenses will be greater than the tax increases, “and added and to the degree that your employer saves money, especially for union workers, our view is that the workers should benefit from those savings. Okay?”

Sanders has proposed a requirement that employers pass on savings from M4A to employees, but only for those who are union members. The man was unconvinced that his employer would demonstrate such largesse.

“Well that’s mine too, they’re definitely going to have a savings, I don’t see that translating into any benefit for me, honestly,” he told Sanders, who responded with belief rather than facts.

“I think at the end of the day you will have more, a better plan than you have right now, it’ll be comprehensive, and no deductibles and no co-payments, I do believe you’ll be better off,” Sanders said.

The problem is that this specific guy probably won’t be, at least not in the hypothetical that Sanders himself likes to use. In defending his plan to CNN’s Jake Tapper in July, Sanders said “Yes, it’s going to mean higher taxes.  But if I raise your taxes, say, hypothetically, by $8,000, and I remove — and I lower the health care costs that you’re now paying with premiums and deductibles, which are now $12,000, you’re $4,000 to the good.”

But based on Kaiser Foundation data, this guy probably pays about a grand a year in premiums, and with a $500 deductible, he would need to rack up $6,500 in uncovered charges to break even under Sanders’ example. That’s more than the average person racks up in covered charges in a year, and a quarter of people covered by employer-sponsored insurance don’t use any health care services in a given year.

And if his plan, like many private plans, has a managed care component, many of his services would be paid for without needing to satisfy the deductible if he stays in-network. According to Kaiser, the average out-of-pocket expense for a single person with employer-sponsored health insurance is $800 a year. So this guy stands to save $18oo bucks on health care in exchange for an $8,000 tax increase and, since he’s not in a union, a $6,000 pay cut.

Sanders’ example looks even worse for a married couple who each have employer-sponsored plans, and whose out-of-pocket costs are next to nothing when their benefits are coordinated.

Later in the same town hall, a physician asked Sanders how he would deal with lower reimbursement rates, and “maintain the interest and the pay of physician so we keep the brightest in that profession?”

Sanders responded by simply rejecting the question, and while he admitted the need to attract more doctors and nurses into the medical profession, he provided no answer as to how Medicare for All would accomplish this.

In fact, one of the key promises Sanders keeps making about M4A is that people will be able to keep their doctors, without any concern at all for how the plan could affect provider participation rates.

Anyone who remembers the rollout of Obamacare will recall how the media relentlessly hyped false stories about people who were supposedly hurt by the Affordable Care Act, but people like this worker and this doctor are exactly who will be all over cable news in the general election, and their stories won’t be false.

But attempts by M4A Democrats to address these concerns — which are largely tied to the tremendous potential for disruption in the health care system — have ranged from non-existent to disastrous.

Sanders spent years waving them away, then suddenly backed a narrow carveout for unions that simultaneously confirms the legitimacy of concerns about disruption, while doing nothing to protect most American workers from it.

Kamala Harris made the wise decision to address disruption by releasing her own M4A plan, but her plan doesn’t so much solve the problem as put it off for ten years. Elizabeth Warren’s plan has thus far been “I’m with Bernie.”

And Democratic opponents of the plan have been inept at criticizing Medicare for All, resorting to misleading attacks that succeed only in damaging a very popular concept. They’d all be better off agreeing that everyone should be covered, and explaining why their plan is better.

Harris probably still has room to tinker with her health care plan, since her appeal in this primary is more as a Trump-slayer than a policy wonk. Warren also has room to maneuver since she hasn’t released a plan of her own yet, but she can only stray so far from Sanders’ M4A orthodoxy and still retain the enthusiasm of the Sanders crowd.

All of them need to figure out how to answer tough questions from (checks notes) people at Bernie Sanders rallies. Just knowing what a deductible is isn’t going to cut it.

Watch the clip above, via Bernie Sanders for President.

This is an opinion piece. The views expressed in this article are those of just the author.

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