She just just say, "Mexico will pay for it."
12
It's really easy. Just put everyone on the Federal Healthcare Benefits Plan only call it the USAHBP. It's like the ACA on steroids. Private insurance market, regulated, you get a choice of what kind of plan you want and because of the enrollment numbers, the price is reasonable. Medicare covers the start over 65 and FEHB covers the rest. I haven't paid a bill other than the insurance at $3000/yr for the family plan since 2006 when I retired from the PO. It's not magic people. It's just insurance, you do need to make people buy it though. If they can't afford it, subsidize them.
Just Medicare is not the solution, it doesn't cover everything but it's a good start.
7
Medicare for all is never going to happen nor is UBI. Just think of the global tsunami of human beings that would hit the West. Look at how a paltry one million immigrants is turning the West in the semi fascist direction. It would be civil war and Elizabeth Warren and Bernie are therefore dangerous.
Dear Professor Krugman,
Why are you defending something that you know does not make sense? I esteem you as an economist. But I don’t get why you are such a reactionary when it comes to Medicare for all? You know it is entirely doable as a single payer system. The cost savings are commensurate with the tax increases if not significantly more. Instead of pontificating, calculate them and tell all what they are. You with a first year grad student can do that in a couple of days. Healthcare is not a business. There is no need to have private companies involved in insuring people. Tell me why it is not the case? We have an army, navy, air force, NIH and NASA. All non-private and best in the world. So why wouldn’t public insurance work?
I don’t know what psychoanalytical problem you may have with it but you have acted like a center right pundit when you have the brains to be better than that.
Can you please explain clearly and with numbers to back your claims as if you were trying to publish in an academic journal?
The Times does not like my comments (when they get published once in a while, readers do though) so most likely they won’t print this one. If they do, and you happen to read it, I hope you will be a mensch enough to answer with analysis and not with ideology. The second is malarkey, the first won you the Nobel prize.
13
The 'reluctance' to Medicare for All is all about Health investor wealth in the Wall Street casino.
$$$$$$$$$$
https://eresearch.fidelity.com/eresearch/markets_sectors/sectors/sectors_in_market.jhtml?tab=learn§or=35
5
Lighten up Paul et al. What are you so afraid of? You should be afraid of war, climate change, over reproduction and the Wall Street vultures helped along by all who think interest rates should be negative and we shouldn't have tariffs.
Just admit you don't like a funny, gutsy woman running for president. (She is no Hillary -- she got there more or less all by herself... and knows how to study problems.) I don't blame her for being vague because GUESS WHAT -- we don't know exactly what might happen with Medicare for All.. One could start with eliminating all private insurance for all taxpayer paid person and all of a sudden the number of people with private insurance plans goes way down.. (Please someone do the numbers.) and please point out that Medicare Advantage plans are insurance company plans along with the supplemental plans - my money for that could go straight to single payer. I'm sick of disingenuous (on purpose).. If you don't like the lady, just say so. (You know I just hate uppity women.... ;--].)
3
What Warren should say: Part I.
[Part I explains what Med-W is. Part II completes the "what" and then explains how Med-W would be paid for. All TK numbers to be filled in by professional healthcare economists, not Sean Hannity.]
I want to first distinguish my “Medicare for All” from all of the other proposals out there. Let’s call mine Med-Warren, or Med-W for short.
Med-W will cover all expenses. Premiums, co-pays, and deductibles, will disappear, and will be paid out of general revenues, which is to say tax dollars.
Med-W will also include all Rx Drug expenses covered by an expansive formulary, as in Medicare Part D.
Dreamer?
Yes, a dreamer, but one who is able to Imagine the future in a hard-headed way.
How will I do this?
First I will roll out Med-W in cohorts. And there will, from the get go, be in depth testing of outcomes, both medical and financial for each cohort, so that Med-W can be fine-tuned in actual practice for the initial and subsequent cohorts.
Med-W would not have a rigid time frame for transformation of the entire current health care system. It would be tried, tested, and, as a result, turn out true for all the American people.
The first cohort?
Those who are currently on Medicare but require Medicaid to supplement their premiums, deductibles, and co-pays. This is an estimated TK people.
The second cohort?
Those who currently are uninsured but fall in the gap between Obamacare and Medicaid. This is an estimated TK people.
[Cont in Part II.]
1
I still agree with this editorial about "a better health care system". https://www.nytimes.com/2019/02/20/opinion/health-care-germany.html In it, the writer explains how the German system includes options that allows people to choose what works best for them.
This direction makes much more sense than trying to change our healthcare system right now. With so many problems created by a "hospitality guy" in the WH -- ignoring climate change and allowing corruption run rampant overseas, I'm not ready to see 'revolutionary' (socialist) changes in the healthcare system now.
2
What Warren Should Say: Part III
[Part III finishes the “how to pay” story. All TK numbers to be filled in by professional healthcare economists, not Sean Hannity.]
My professional advisers, subject to peer (not Tucker Carlson) review, estimate no one making less than $1m will have to pay a nickel extra in taxes over what they are now paying to fund the first two cohorts.
Trust me, the numbers are there, and with a lot left over for changing our priorities in the tax system.
And there will still be a lot of money left over for rolling out additional cohorts.
So…
In addition, I will open up the test in the early stages for an income and demographically based inclusion of people who want to voluntarily come into Med-W on a four year phased in basis:
• Year 1 they would pay 90% of what they now pay for premiums, co-pays and deductibles, as if they were in an Obamacare Gold program.
• Year 2 that would go down to 60%.
• Year 3 it would go down to 30%.
• Year 4 it would go down to 0%, i.e., they would be fully absorbed into Med-W.
All of the details of Med-W, including an anticipated roll out schedule for other cohorts, is at my special website. Med-Warren.com.
Have at it FoxNews and Vladimir Putin! Get busy trying to confuse people with misinformation about Med-W, on air, Facebook, Instagram, or wherever, which misinformation they can dispel by reading about Med-Warren in its full context in black and white on Med-Warren.com.
1
Another brilliant very insightful commentary by Krugman.
I will sum it up in two lines and you can save yourself having to read Krugman's verbose version:
Warren is in a deep hole she dug for herself. Will she be able to get out of the hole? (Krugman has no answer)
3
Ok, NYT readers pushing for an "option"; how are you paying for it? What does it cover and what is excluded? Will the Corp. Insur. be dumping the sick and poor into this pool?; or will they be prevented from denying and canceling existing coverages? If you don't prevent this, it is just a larger Insur. Profit giveaway. One that will bankrupt this "option" unless prevented.
You proclaim 'merican's like having choices. So...what are the choices. TELL us what this "option" will be and how it is paid for?!
Or is this just another Conservadem denial, bait 'n switch?!
C'mon guys. What is this glorious "option" plan and how are you paying for it? What's in it?
3
Elizabeth Warren is a terrible candidate with terrible policy positions. No matter what she comes up with, Warren is not appealing. On top of that she is a liar. I would have hoped the Democrats would have come up with a better female nominee that her. Looks like Trump wins it in a landslide.
2
Nobody seems to have addressed what will happen to the money that EMPLOYERS currently pay INSURANCE COMPANIES. Even though it is not a direct cost to consumers, it could be considered that this "belongs" to employees as part of their compensation. If employers increase employee paychecks by this amount, GREAT. If employers give this money to the government to offset the cost of M4A, GREAT. But if employers are able to keep this money, that's not so great and it confuses the accounting around M4A. This is what Warren should address.
2
My words for Warren. “Look, I’m a bottom line girl. If my family budget requires me to spend three dollars for taxes and two dollars for health care insurance, then I’m out five dollars. If the government says ‘Whoa! We’ll provide your health insurance, even better than what you have, but your taxes will go up to four dollars,’ then l’m out four dollars in taxes, and I save two dollars in private health insurance. That leaves one dollar in my pocket. I like that. Some people might not like that, but I like that, and I bet you’ll like it, too.”
3
Paul Krugman continues his discouraging crusade against Medicare for All. Disappointing to say the least.
After grudgingly admitting that MFA would probably make most people better off, he falls back on the familiar hedge that it's politically unviable, since it represents such a drastic 'leap into the unknown'. Well how about trying to make it less of an unknown? For starters, why not cite a reputable study or two (there are several available) arguing that MFA will in fact reduce health care spending and provide better coverage for more people. E.g. this study from the Political Economy Research Institute at UMass Amherst:
https://www.peri.umass.edu/publication/item/1127-economic-analysis-of-medicare-for-all
If unreasonable fears are the main obstacle to MFA becoming a political reality, let's attack those fears, not continually defer to them as some sort of immovable reality.
2
Right now, $22,000 of my compensation is being handed over, pre-tax, to a Blue Cross / Blue Shield 'health insurer' to cover the cost of health care my family and I receive. [I put health insurer in quotes because they really are a benefit administrator, not an insurer.]
My wife is forgoing about $18,000 of compensation from her employer, because she's covered under my plan. The difference is because she would have to pay about $7000 in salary contributions as well, while I only have to pay about $3000 in salary contributions. But both family plans have total cost at $25,000.
Anyway, for me, I would be fine with paying $3000 in taxes and having my employer send the $22000 to Medicare. Or give me the $25k and I'll pay it all in taxes. At the end of the day, it's the same thing. Same net pay, same benefits.
For my wife, it's crazy that her employer enjoys a $18,000 windfall because she's covered under my plan. That's money they are prepared to pay in exchange for her labor. She should get that, not them.
Warren's challenge is to work out a system where employers don't reap a windfall from the end of employer benefit plans. It's a tough nut to crack, but basic economics teaches that employers have to compensate employees fairly in a competitive labor market.
I don't think people are too stupid to understand that their net pay and benefits is what matters, not the 'sanctity' of the supplicant-insurer relationship.
10
Why worry that your healthcare is at the whims of central planning politicians that change direction every 2-8 years. How's that federal funding for abortion going? (That's REAL central planning in action with respect to healthcare. Contraception isn't far behind.)
I am a dual citizen - American and Canadian - currently living in Canada. As a retired professor of economics I think my perspective on Canada's single-payer health care system may be of interest to readers of this column. In evaluating single-payer systems like Canada's you must keep several things in mind: (1) wait times in Canada can be very long; (2) some procedures are not covered by this system; (3) It is not really true Canada's system is a comprehensive single-payer system: dual options in which one opts out of the slow and immensely bureaucratic system exist, but you have to pay for these fast-track procedures; (4) My general conclusion from dealing with the Canadian system is that it is failing in many areas, notably in enrolling young doctors into family medicine as opposed to specialties that yield much higher rewards in Canada or for that matter abroad where many Canadian doctors go. I believe a competitive universal system like that of Germany would be a far better model for progressives in the US to emulate than single-payer. Warren and Sanders are making a big mistake staking out a single-payer model.
7
I'm 77 years old. I'm covered by Medicare. I have severe concerns about the potential impact of "Medicare for All" on how medicine would be practiced and the ability of all those involved in delivering medical care to financially survive.
I am currently being treated for cancer, multiple myeloma. The cancer was first diagnosed on 8/25/19 and I've been receiving diagnostic tests to confirm the diagnosis, determine the grade of the cancer, and various medicines to treat the cancer.
I recently received records from Medicare showing the amounts billed for the first month of medical services and the amounts Medicare actually paid to the different service providers:
Totals Billed for one month = $20,733.50
Totals Paid by Medicare = $1,851.66
If Medicare for All means that the government will determine how much to reimburse medical service providers for each and every service and the amount of that reimbursement averages less than 10% of the billed cost, how will the service providers remain in business?
Will Medicare for All result in fewer medical service providers (hospitals, clinics, group and individual practices) and fewer men and women wanting to enter the medical profession? Will the quality of medical service deteriorate as fewer medical professionals have less time to see more and more patients?
We need to know all the details and all the logical consequences of any Medicare for All proposal before it can be rationally assessed.
3
Her doctrinaire opposition to ANY suggestion that a gradual approach would be more practical as well as politically appealing is a turn-off to many liberals. We are now looking around at more reasonable candidates.
2
Great article Mr. Krugman. Something like 75% of people with an employer plan like it. They know exactly what their monthly premium is, and how much they're spending on deductibles and co-pays. They know they spend alot, and they aren't happy about it, but they prefer something they know to something they don't know. Warren needs to be very specific. Use a family of four example and show a before/after picture of cost versus taxes. If she can't do that she doesn't stand a chance.
1
Sold my company, so now I'm on COBRA bearing the full $32K costs for a family of 5. But, I'm really afraid a government plan would just lock in our antiquated healthcare system and save costs by rationing or eliminating when, let's get real. A ton of medicine could be automated and/or done by much lower level technicians. Most health problems could be handled by a tech backed by some AI. Doctors only needed for the rare or outlier case.
2
Amen. I hope she is listening. We cannot afford four more years of Trump.
1
I'm for Medicare for All eventually, under the right conditions. As a transition, I would be happy to accept a public option. I am an independent contractor. A public option would really help me and many others. Subsidies for those who can't afford the premiums would be essential. Universal coverage is essential--how we get there is up for grabs. If we look at other countries, they have different systems. I would be ok with private supplemental coverage, similar to medigap plans, covering what Medicare does not.
The USA is very conservative as a country and Democrats had to fight tooth and nail for the Affordable Care Act. It it didn't take long for Republicans to sabotage it. If a public option can pass, I say let's go for it. If single payer emerges as the best option later, we might actually go for it. Meanwhile, progress, not perfection.
2
"My fellow Americans, it would be nice if we had a choice to continue with our current hybrid of private and public sector health insurance coverage, but we really don't.
Our healthcare costs about twice Europe's, let's call it $20,000 per family of four just for premiums, instead of $10,000 in taxes that cover everything. And we only get comparable results, not better.
Consider this: One reason why your wages have been relatively flat for decades is because your employer is paying for your healthcare cost increases instead. And we know where that money has ended up: With the top 1%.
It's time for big, structural change.
Under my Medicare for All plan, you and your family will be covered for all of your healthcare needs. You pick your doctors and dentist and they bill Uncle Sam.
We know that removing insurance company overhead and simplifying billing can remove about $3,000 of that $10,000 gap per person with Europe.
By giving a panel of expert doctors and nurses the power to set prices across the healthcare industry using international benchmarks as a guideline, we'll get the remaining $7,000 of that savings over time."
--President Elizabeth Warren, January 2020.
3
Health care and its obstruction to Medicare for All is all about protecting the lucrative investor wealth in the Health sector of Wall Street!
The skeptics also include the Finance industry busy growing wealth for those concerned with the recent turbulence in the Wall Street casino.
No other country trades in Health Profit at the expense of lives and people's health!
3
This debate is fun, but let's stop acting like we have a choice of whether to do Medicare for All or not. Unless we get healthcare costs down dramatically, our federal budget explodes and our taxes will be dramatically raised anyway.
In case nobody noticed, our deficit was $1 trillion this past year, in a very strong economy. It would have been $600 billion if Obama policies had continued, still sizable. CBO continues to report the trajectory is unsustainable, driven by an aging country and healthcare cost inflation primarily.
And the only way to get those costs down is to give the government the power to push down prices; there is no market solution. While an "ACA on steroids" strategy can cover everyone, it doesn't address the cost issue.
And let's not kid ourselves; the $300 MRI in France vs. $1,200 in the U.S. is not about process or markets. We have to remove the insurance company overhead and give the government the authority to push down prices, taking healthcare down from 17% GDP (about $3.5 trillion/year) to around the 9% GDP of Europe (about $2 trillion).
So we're hunting $1.5 trillion in cost savings per year. The insurance company overhead is about $350 billion/year.
The rest is pushing down costs to European benchmark levels.
4
@David Doney
but when we push the $400,000/yr urologist down to European levels, who will pay the $100,000 per year college education for his kids - the EU? Who will pay his malpractice insurance etc.
The reason Warren is on "costs" rather than "taxes" is that costs is where it's at but it isn't all black and white because culture is a big part of what has to change.
She's on the right track. Klobuchar and Buttgieg are spinning their wheels while the money rolls in from big pharma and big insurance.
3
If you think Doctor availability is bad now, imagine what it looks like if you slash their wages by 25 or 30 percent?
Same for nurses, research scientists, engineers etc......and orderlies, home health care and therapists make minimum wage as it is.
2
I'm all for M4A, but I agree it has to be sold to the American people a little better. Many people with employer-supplied health care aren't aware of how much it's costing them, between payroll deductions, co-pays, coverage limits and deductibles. The private insurance administrative costs are outrageous, with layer upon layer of middlemen adding significantly to our costs. After 45 plus years in the workforce, my current medicare coverage is working more smoothly and efficiently that any of my former employer-supplied insurance ever did. Besides, nothing Warren proposes is anywhere near as radical our current president's views on pretty much anything.
94
Okay, Bernie Bots.
You all handed trump the election in 2016.
Can you all get behind whoever the Dem nominee is?
And I'm talking to all of you, college students and millenials (who bernie is buying off w/that nonsense college tuition ploy that cannot possibly be paid for).
1
Warren and Sanders both grew up during the post world war II boom years with enormous deficits well offset by enormous growth and sharing of the proceeds by all. That ended very abruptly in 1973 and every politician since then has been hoping to restore it and denying that it's over for the indefinite future. Both Democrats and Republicans have being hoping that operating with borrowed money for budgeted costs will only be temporary and be followed by growth that resumes a pay as you go kind if government funding. All it's done is underfunded both infrastructure and the public services which were intended to offset wealth inequalities.
Warren wants that to end and to be corrected, quickly. But the fact is that the domestic economy is not providing the means and capturing the wealth produced globally and profiting the very rich is probably not going to happen.
1
Here is an idea I have not seen proposed which would be a step in the right direction: Allow people in ages 55-65 to be covered under Medicare at a premium price comparable to the market rate.Employers would find it advantageous to offer their employees financial incentives to elect such option (essentially underwriting)to give up existing group coverage, Removing higher risks from their group insurance risk pool would likely result in employer savings. Win ,win
2
One thing I'm wondering: Warren's argument is that I will save money in the long run. If my insurance is completely covered by my employer, will my salary increase? If not, I will not be coming out ahead.
4
If one reads the Tenth Amendment, the only way any federal medical program exists is because five Supreme Court justices, at any given time, have ignored it. It would behoove us to enact another amendment to protect Medicare. Indigent medical care should be left to the states.
Medicare for all would increase expenditures for CURRENT recipients by twenty percent.
Under the commerce clause, Congress has the authority to permit health insurers to operate nationally and to regulate their capitalization, premiums, and coverage.
This can't only be looked at from the patient perspective. Medical professionals are in a constant war to preserve there benefits, be the right to prescribe -- only some states allow clinical psychologists limited rights in this specialty. And what about chiropractors, optometrists or chiropodists.
Medicare would pay maybe $40 for certain professions to clip toenails, every few months. Of course a high quality clipper is available for $5- which lasts forever. And then there's something called the Wellness visit for retirees-- your MD does a few paper and pencil tests -- which can be subcontracted, and like it or not -- he/she will tell you that you have alzheimers.
Maybe you could have denied it for a few more years, but ACA decided it's better to be profoundly depressed by this incurable affliction. This was inserted under the radar, so you can imagine who many such decisions will be for "Medicare for All"
Each of the 11 persons on the debate were given a full 50 seconds to describe their plan. Accepting this absurdity should have be the insult that at least one person would have refused to accept.
1
Warren will not escape the Medicare trap until she has hard evidence that it's costing her a significant number of votes and she realizes that it is just one way to achieve what she seeks.
This is where Warren is showing a flaw in her political abilities. The successful politician relies upon what is possible. Medicare for All is an aspiration. It proposes to be a smooth and direct means to achieve a single payer, universal system which costs about the same as those across the world. The obstacles are simply being dismissed as bumps in the road not real barriers.
We pay twice as much as other countries for medical care. The administrative costs are far too high. The money spent on diagnoses and treatments are far too high. Just reducing the profits of insurers is not going to eliminate the discrepancies. We also need to introduce a rigorous system of reviewing and evaluating and revising how we do things. The Medicare system is designed for old people, not people during their entire lives. It's going to have to change a lot to meet it's revised purposes.
Warren is trying to low ball a sale, here, and is minimizing the uncertainty and scope of the resources that will be required to achieve what she and Bernie propose. The electorate senses this and it's hurting her credibility.
2
Two thoughts:
Current health care system is a monopoly and scam having nothing to do with health and all to do with the hospital industry and insurance industry piling on and double dipping on all costs.
Democrats are stupid to shout “how are you going to pay for this?” at Warren basically doing the Republicans a favor. It is obvious that a single payer system would lower your overall cost and increase your salary as companies stop having to be health care insurance providers.
To summarize:
Current health care = scam
Dems stop attacking single payer and protecting that scam!
3
Warren almost as bad a Hillary! I’ve heard enough from both of them.
2
Medicare for Seniors is a success story over a long period of time. You, then, present a proof by assumption kind of 'logic' that expanding Medicare to younger demographic segments with fewer health issues than Seniors is doomed to failure.
The ACA is a monument to adverse selection. It is falling of its own weight and the subsidies only grow.
3
Listen up Liz! Don't promise the kids a pony when the reality is that it ain't gonna happen any time soon. Tell them they're getting a gerbil, but we'll keep working towards the pony.
1
Warren leaned a bit too far to the left, fallen and can't get up.
3
@Mark Shyres A bit too far? Wayyyy too far!
1
Warren has painted herself into many corners. How about eliminating student debt or medical coverage for illegals. Maybe the liberal media should have been as hard about her alternative reality as they were about Trumps.
1
The experienced ivory tower academic turned novice rookie politician little Betsy Warren doesn't have much common nor street sense.
Despite being a diva narcissist septuagenarian in denial with her dyed hair and make-up, Warren is a babe in the woods.
Next to a ignorant immature immoral inarticulate incompetent inexperienced intemperate insecure bloviating buffoon diva narcissist septuagenarian spoiled rich moral degenerate brat like Donald Trump. She foolishly fell for his tweets and taunts.
Warren faded and folded like a funeral home rose petal under attack during the Democratic Party debate. An off-putting mean spirited school teacher who clearly is not ready for prime political mass media time.
Smiling and smirking Vladimir Putin will play her like the big bad Russian bear that he is. While she goes all Chihuahua barking back at him.
Warren is obviously trying way too hard. And her forced posturing comes across as acting. Betsy is too fake to matter.
2
She may become president, despite the NYT op-ed column. She has taken a stand that Ariel Sharon has taken, and that is unacceptable to all of your peers. So sad, because I really think she could do some good as president. You are the one columnist without a litmus test on that subject. That is why my subscription expires today-- t much news shaping, not enough reporting the news.
1
Medicare for All is a loser in the 2020 election.
1. Fix/improve Obamacare
2. If you're covered by your employer and like your health insurance keep it. Realize that over time more and more costs will be shifted from the employer to the employee
3.Do you think that those who are employed by the Insurance Companies are going to vote themselves out of work...?
Warren,Sanders and Biden....yawn.... are losers in 2020
Amy and Pete....offer inspiration for everyone
2
What Warren really needs is the best possible propaganda attack she can muster. That's the only way to do business in the mindless USA.
Trump promised trillion dollar infrastructure--Where is it?
Trump promised The Wall------------------------Where is it?
Trump promised to Drain the Swamp----------Where is it?
Trump promised to save Ohio GM Plant-------Where is it now?
And Yet, And Yet
Elizabeth Warren must come through and proves she's Saint VS Trump Sinner.
2
I want to know what her plan would cost ME. I'm 73 years old and covered by a full-coverage HMO paid for by the State of Illinois, and this plan is currently guaranteed to me for life by the Illinois State Constitution. Lots and lots of other folks in this city are too (for obvious reasons).
I also would want to know how my coverage would be harmed. Improved? I'm 99.999% sure it would not be helped.
So would lots of other people!
Also ... as we all perfectly well know, despite the lies to the contrary, Medicare for all would entail unappealable death panels. Sure, HMOs have death panels too, but the courts have a say in this too. That would be turned off for a government plan. ALL single-player plans end up with ruthless death panels. For instance the ones in Britain are so ruthless that they can keep people in the country to die rather than letting them seek treatment elsewhere. We in the USA will not tolerate that.
Lots of people in the USA would see $30,000 cuts per year
in their spendable income due to Medicare for all tax increases set up by the far left wing people Warren represents. We would not like that.
1
Yes - spot on analysis by Mr. Krugman.
Fully supporting Biden and/or others who offer Medicare-for-all-WHO-WANT-IT. Warren would be my top choice otherwise.
3
Policy wonk Warren on healthcare reform vis a vis no holds barred single payer for all will not win the political battle — period!
Americans are not there yet.
Add in the forthcoming tsunami of corporate billion dollar counterattacks and the odd become abysmal.
Four more years of Trump? Gotta be as bad as it can possibly be.
America will for all purposes be a basket case heading straight for the trash heap of great nations.
1
According to the CBO, Medicare pays approximately 50 % of what Private Insurance pays for the same procedures. Why in the world would the US Medical-Insurance complex, which is one of the richest and most well organized lobbies in the world, allow any candidate to close of this gold mine. They will kill her candidacy long before she becomes President. Obamacare and the Bush drug benefit for seniors passed Congress because the Medical-Insurance complex was fully on board with higher payouts for all.
4
What you don't get about Warren is that she is anti-greed.If the health insurance capitalists were eliminated, how much more efficient would that be? Just the government employed Medicare workers, whose numbers would increase. We wouldn't be paying our taxes to greedy health insurers. The money ultimately saved could be used to pay for infrastructure or other essentials.
I love my Medicare. It pays almost all my costs. I pay for more my supplemental insurance through my union than I get charged after the Medicare payments. My supplemental insurance is really just a gamble that I might need it. My Medicare is the best thing ever. Everyone deserves it. People shouldn't be shelling out money to pay for unnecessary middleman insurance salesmen's commissions and greedy insurance companies' paper pushers' minimal wages. Elizabeth is trying to protect the middle class who don't want to be paying for hospitals' grand pianos in the lobby.
3
@Sweetbetsy The problem with "your Medicare" is that it's headed toward bankruptcy. And if you trust people worth $12 million to be "anti-greed", well. you definitely get an 'A' for optimism.
By the way, as a middle class music teacher, I think grand pianos in lobbies are a great idea.
3
"The election might, however, hinge on the support of people who have good private coverage and would be nervous about making a leap into the unknown . . ."
I don't understand this supposed fear of the "unknown". Surely people have or have had parents covered under Medicare? I would think there would be little that is unknown about how that program functions. As far as private insurance is concerned, couldn't that be retained by continuing to have Medicare Supplement policies such as those currently in use under Medicare? Perhaps that could be part of a phasing-in process?
It didn't take decades to create Social Security or Medicare. It took Franklin Roosevelt and LBJ. The republicans fought tooth and nail because they knew that once voters became familiar with those programs they would become overwhelmingly popular, more or less instantly. That is exactly what happened.
I don't care how we get to universal public health care. A fully comprehensive taxpayer funded public option offered through the ACA be just as good as extending improved Medicare to everyone in the sense that both will strangle the life out of private health insurance companies, whose business model is to become wealthy by denying health care coverage to as many people as possible. Make the insurance companies compete with a no cost public option or with improved Medicare. When people (and employers) realize they can obtain excellent coverage for low or no premium cost, or they can continue to send their insurance company money every month for inferior coverage that's likely to be denied, whatever we call it will become just as popular as Social Security, Medicare, ice cream, and puppies.
3
While "medicare for all" is a worthy goal, since we are not starting from scratch, it will take a decades long transition period of consistent policy. If the GOP has enough voting power they will spend at least the next 10 years trying to gut anything meaningful that can be accomplished in this direction.
Before any universal type plan can work here, costs need to come down both for care and for prescriptive medicines. An increase in revenues for the Medicare treasury should gradually build up with minor incremental increases in the tax. A public option to compete with private insurers, particularly for individual plans which are way overpriced, to bring the cost of private insurance down or maybe to prove too competitive for their survival. Investors and Pension plans investing in private insurance stocks should move to divest. Most of us will not be the beneficiaries of an eventual Universal Medicare for All type plan, but we should work to make it possible for future generations. In the long run, it's the only solution that will be affordable and best accommodate the public.
2
The public option is by far the best way to go and will prove itself overtime. Why is there a need to force M4A on those that don’t want it? Let the chips fall where they may without trying to close down an entire industry in the process. Hopefully EW can present such an option without alienating the far left/Bernie supporters, she has bigger fish to fry and taking a more moderate position on this while allowing her to go full throttle forward with a more popular WEALTH TAX will go a long way to right our capitalist-free-market inadequacies and imbalances.
1
I voted for Bernie in 2016 and a big supporter BUT these purity tests demanded by some of my fellow supporters will be a reason democrats lose the election.
1
@Mal Stone
You have an Op-Ed and a comment section full of frothing centrists...and you claim your fellow supporters are the ones demanding "purity" tests?
Sorry, but I have to call into doubt your supposed Bernie bona fids. Especially parroting the lie that Democratic's lost and will again because of these made up propaganda entities.
As a supposed Bern voter, you'd know that the 10 million Dem/DINO's flippers easily out distanced the few thousand Sanders primary voters who flipped or abstained.
Not buying it.
Just another false flag operation.
Must be the Brock silly season if full effect.
3
Take a look at the Mexican social security system. Employee and employer pay a tax for government run medical system (as in Europe) but private hospitals bare also available as well as private insurance.
BTW drug prices are way lower south of the border.
1
Krugman writes, "More than half of Americans are covered by private health insurance, mainly through employers." In other words, most Americans with private health insurance aren't paying the premiums. This reality will make them impervious to "total cost" arguments because their employers are currently paying the bulk of their health care costs.
2
Simple answer to a simple question: NO.
1
Rather than use his platform to advance adoption of a humane and civilized health care system, Krugman is always keen to tell us why single payer is not feasible. He rarely addresses the failures and tragedies endemic to our current system—from preventable deaths, to bankruptcies, to delays and denials of tests and treatments, to the lack of freedom in choosing doctors or leaving unfulfilling jobs. What does he propose beyond resigning ourselves to a terrible status quo? Must our public policy be driven by fear and subservience to special interests? Or does even raising these questions make one a “purist”?
3
This reader used to be all-in on Prof. Krugman. I even signed up for the blog. The prof used to treat a wide range of economic issues; in many cases he explained rather than proselytized. Trump ended all that, and now the prof is a mere spear-carrier in the effort to evict Trump and rewrite the 2016 election--although Hillary's evident paranoia might make someone think twice about that.
So, I read the prof today and wondered: why the sudden caution; why all the "maybes" and "possibly" stuff. If a macroeconomist doesn't have the ultimate answer (as all good progressives should), what's going on? Is it possible that there is NO plan for reaching utopia? Maybe--just maybe--government shouldn't expand into what is now a very screwed-up "system" (a misnomer); perhaps there are ways to gradually and carefully reform medical costs that might have some metrics attached that would actually--beyond the hopey-feeley progressive stuff--tell us if something is working. And if it isn't, to modify, tweek, adapt.
Might be worth a try.
Medicare for All? How about Medicaid for All? Because that's what's likely to happen if Sanders' plan is ever implemented. Does he seriously think that the government will be able to pay for eyeglasses, dental work, hearing aids and everything else for everyone without blowing a gigantic hole in our already huge annual budget deficits? And Warren's Medicare for All plan and be-damned private insurance is no better.
Even in Germany, France and England there's a role for private insurers to play in augmenting the very basic plans offered by their governments. Sanders' and Warren's insistence on the abolishment of private insurance borders on the Stalinesque to me.
In the U.S., Medicare DOES NOT pay for eyeglasses, dental work and hearing aids. What it does pay for is only 80% of your approved health care costs. For 100% coverage, minus your annual deductible and co-insurance fees, your options are to either sign up for a Medicare Advantage plan (think HMO), which limits your access to providers and various services but charges you little to nothing in return, or pay for a Medigap (aka a "Medicare Supplemental") plan, which is not cheap.
"Pie in the sky" and a losing argument in 2020 are exactly what Sanders and Warren are promising us.
4
The problem with a plan for healthcare is the ridiculous amount of complexity that exists across all myriad types of stakeholders. The desire to tell a simplified story is a bane. The notion of "blowing it up" mobilizes too many counterforces (even on the same side of the aisle) and makes it easy to demonize. Here's how I would proceed:
1) Paint a positive strategic intent, a vision that people can look at as common sense that the majority can look at and say they're able to accept i.e. lower healthcare costs, access for all, types of innovation, etc.
2) Acknowledge the forces against it, change and disruption is hard i.e. this is going to require a "hero's journey"
3) Sketch out the "logical" journey and assumptions... Today --> Step A --> Step B --> Step C --> Vision... Bring America along on the journey to reduce the various fears of "helping the undeserving" or "losing out"... Each step can be contingent on meeting key assumptions at key milestones. Position each ensuing election as the way America decides to continue on this journey.
Practically, this is how any change would happen anyway.
“People like their private plans until they or a covered family member becomes seriously ill”
We are retirees on a Medicare Advantage plan - For the past year we have been disputing a bill from a skilled nursing center in excess of $2,500 for services billed as ”acute” (we have never seen any proof as to exactly what that is) or physical therapy (which is 100% covered within the contract plan). In point of fact my spouse received absolutely no care that was not covered under our plan.
Yet, we have been hounded and threatened with our account being turned over to a collection agency.
We have paid our premiums, co-pays, and out of pockets fully, yet I’ll bet we are conservatively amount a million Medicare Advantage plan users that are engaged in stressful, time consuming battles with providers who are bilking patients for services NOT rendered or covered under the plan they pay good money for.
Dealing with insurance companies and providers over services, especially when you are lying on your back or recovering from a hospital stay is like dealing with shark while your trying to save yourself from drowning after the crappy inflatable you relied on broke an air valve because of cheap crappy design.
All I can figure is that a lot of insurance plan users have yet had to actually use insurance of catastrophic care. Healthcare by insurance companies is living proof that, “There’s a sucker born every minute.” - (Associated with) P.T, Barnum
2
I'm so confused with this Medicare rant. Medicare is not free. So why is it being called Medicare? Say Bernie or Liz get their plans through Congress does that mean all us old folks will also get our Medicare free? This sounds like a smoke screen to me.
2
Grandfather in employer-based plans. They will soon disappear. Employers will stop offering them.and replace therm with other forms of compensation, e. g. money.
They are a very inefficient way to compensate employees. They arose during WWII because wage increases were forbidden.
3
Can you not understand that is not the way the government divides up the money. And medicare for all costs controls will go out the window for such as vast system. Medicare has tried for years to eliminate abuse and it measures in the tens of billions.
We can barely manger our government and now you want to add a giant chunk on? AND every state is intimately and powerfully involved in health care. Are you going to eliminate that? Governors will never stand for it.
3
Warren needs to hire a company to do a statistical sample of the population comparing what they now pay for medical insurance, taking into account deductibles, for insurance and what they are paying for supplemental and what they are paying for drugs and compare that to what they would be paying under her plan. For those insured through their company they should be paid in cash for the dollars their employer has previously been paying to cover them.
What it all needs to come down to is the out of pocket cost to the individual or family.
Doctor's should be able to operate with less staff through the elimination of he cost of dealing with multiple insurance companies and fill out different forms for each insurance company. That should give medicare leverage to negotiate for lower costs.
1
As others have said, even with Medicare you need supplemental insurance. AND, some of the costs of Medicare are deducted from social security payments. Will that no longer happen? Will what we get from supplemental insurance be included in Medicare for All? If not, then we'll be getting less than what we (or what some seniors) have now. No one asks Bernie or Elizabeth these questions -- I always wonder why.
Finally, I have Kaiser Permanente. It may not be perfect, but I think it could easily serve as the model for universal health care.
1
Thank you Dr. Krugman for highlighting this issue. I wish that the New York Times would provide more analysis of this issue, including an analysis of the actual funding mechanism of each Democratic candidate because it is so important to voters right now. I have experience in health care administration, and I know the issues are complex. So far, some progressives have not even considered the fact that many employers spend a significant percentage of payroll on health insurance -- why not continue to expect that employers will contribute rather than change the whole system? In any case, a good dialogue is really needed beyond what we have experienced so far.
1
My father had a very serious illness when I was 25 years old. He had a brain abscess. It was the very late side effect to being kicked in the head while he had been in the army 30 years earlier. The accident made a hole in his eardrum and that led to dirty water getting in his "head". That dirt didn't cause any problems for a very long time and then it did with a vengeance. This happened in 1984. He had good insurance and we didn't go bankrupt. However, some of the restrictions in his policy went against what the medical profession and the hospital caring for him had to do in their professional judgement.
He needed to be in a private room. The insurance wouldn't cover it. We said no because of that. The hospital put him in a private room with a private duty nurse. He had to be monitored at all times because of the injury to his brain. That same injury made it impossible to have a roommate. He was often agitated, loud, and frightening. As he improved the behavior stopped. But the insurance company refused to cover it even though it was medically necessary. We said no because we couldn't pay the difference.
My father received excellent care for his entire stay. We didn't have to pay more than a few thousand dollars. There was no managed care network nor any out of network charges. If this had happened now we'd be hospitalized with nervous breakdowns because of the system.
4
Elizabeth, please read Krugman and these comments!
We want YOU and need you to oust the Liar-In-Chief, but it's not going to happen if you continue with your present healthcare message.
And, on another note, you need a catchy brand! How about "The People's President"?
43
@Murray
Yeah, time to pivot away from everything she espoused or promised her Left.
"People's President"? Sure...if your white, wealthy and degreed. Everyone else...not so much huh.
https://www.people-press.org/2019/08/16/most-democrats-are-excited-by-several-2020-candidates-not-just-their-top-choice/pp_2019-08-16_2020-democratic-candidates_0-06/
Sorry, all of us little people know who fights for us...as he's done for decades. NOT just during an elect. primary; only to be told to pivot away from the most important issue/policy/plan that would help We the People.
https://www.opensecrets.org/news/2019/09/sanders-vs-warren-who-has-more-working-class-donors/
4
I have good private healthcare insurance, plus Medicare.
I will vote for Trump before I will trade that in for Medicare-for-all. Add that to the fact that we worked hard to save and save and save to pay for our children's education (which a lot of parents these days don't do, and their children don't do), and now she wants me to pay for people who didn't plan ahead.
And what do you get?
Me shelling out a lot of money for other people.
Thanks but no thanks. Go away Warren. Let a more centrist Democrat unseat Trump. You can't. You are another Bernie Sanders appealing to the far left socialists at the expense of real peoples' lives.
7
This is a positive way to lose an election. The patient has to pay deductibles and copay's to help the costs. Bernie's plan is crazy and Warren needs to rethink her position as it will lose her the nomination and also the general election if she somehow wins the nomination. Lets not lose again over healthcare when other issues are even more important like climate change, clean air and water and international leadership and moral obligations.
1
I thought the same (last graf re purity test, etc.) however it was in the last debate that I realized it went a little deeper.
As I was listening to Buttgieg (who sits at the extreme center with Klobuchar) I realized that as they spoke they sounded more and more like the politicians from 1968 onwards who promised the moon only to surrender to insurance interests (inter alia) as soon as they took office.
The longer Betsy keeps them talking, the more they sound like the people who left us hanging out to dry for 50 years and like somebody who wouldn't mind hanging us out to dry for another 50.
Warren says she will not sign a bill that raises costs for the average American. She says she never met anybody who likes their insurance company.
It adds up to me. Keep 'em talking, Betsy.
p.s. One of the unspoken truths about the politics of Obamacare was that it's feasibility with CBO rested on premiums being styled as "taxes" because that is what made the mandate constitutional. Is it any accident that conservatives can perforce accuse democrats of raising taxes whenever they run on universal health care?
Personally, I would have started my campaign by stating the rich would take care of the poor and the middle class would take care of the middle class. After all, the middle class have a tax loophole which the poor do not have - tax free premiums with employer group insurance plans. That's another big roadblock for dems.
1
Every healthcare system rations care--it's a question of how now if--and anyone who suggests there will ever be a system that does not ration care is living in an alternative reality or being disingenuous.
The United States healthcare system can, with considerable justification, be criticized for rationing largely on the ability to pay. However, the single-payer systems that progressives here in the United States hold up as their ideal model also ration care.
Are progressives prepared to have difficult conversations and make difficult choices about will and will not be covered and under what criteria?
2
The devil is in the details, and the details don't make good talking points. Is my employer going to give me the money that they are currently using to pay my insurance premiums? Is Medicare going to pay doctors and hospitals an adequate amount to enable them to stay in business? Right now, the shortage of medical care in rural areas is directly due to the high percentage of patients on Medicare together with low reimbursement rates. The truth is that blowing up the system could have a very bad outcome and take quite a bit of time to fix, time that sick people can't afford.
Do we really want to flood Medicare all at once with the entire population of the country? Even if it were possible to get it done politically, would it be advisable?
It's complicated. To me, it seems like a better aspiration would be healthcare for all, rather than stubbornly insisting on a particular path to get there. We all know the details will need to be worked out later. Let's just say so.
4
If you want to find a way to lose to Trump, advocate for Medicare for all and total forgiveness of student debt. I llke Warren a lot, but if she gets the nomination and sticks with her "plans," we are in trouble.
3
@RKEsq
I think Warren has good intentions but forgiving student debt, especially for people making 6 figures, which Warren's plan does is deal-breaker for me. I find it horribly unfair that people like me, who have never made anywhere near $100,000 paid off their debt, while the upper-middle class gets a bailout.
As for Medicare for All, I'm skeptical but willing to hear what she has to say and give her a chance to present a realistic plan.
However, as long as she is advocating for unconditionally forgiving student loans she is not getting my vote, nor is any other candidate who supports this idiotic and unfair idea.
29
@Louis Do you really think the wealthy even took out student loans? NO! Anyone who has taken out student loans at this point, did it because they HAD to in order to go to college. We need to make a clean start: loan forgiveness and then no need for future loans: debt free public education, grants/scholarships for those who qualify on merit, but have financial need, for the private universities, and no more loan forgiveness once there is no longer a need to go into debt to go to college, to prevent the wealthy from taking advantage.
1
@ginny,
Elizabeth Warren wants to include $100,000 incomes as part of her forgiveness--if you don't believe me go ahead and check out her site.
In universe is $100,000 "poor?" Perhaps for a family of four in San Francisco it is but for most of the country $100,000 a year is solidly middle class, if upper-middle class.
If you are making $100,000+ a year and can't pay off your student loans, you're making some poor life choices.
If you want a "clean start" feel free to refund me, and everyone else who has paid off their student loans, the thousands of dollars. Failing to do otherwise is arbitrarily picking winners and losers and not much different that the atrocious bank bailouts during 2008-2009.
1
@Adam (who thinks he knows what his medical costs will be in the future for sure)
Really? I don’t believe you can forecast your future medical bills with certainty. No one can unless you have access to someone up there.
The probability weighted expected value of expenses discounted back to today would give you a good estimate. That is not what you are doing most likely. You, like so many others look at their current health and if they are ok they believe you are going to be ok forever and therefore your costs will be minimal and your taxes going up to pay for the probability of future catastrophes don’t enter into your radar screen. Common problem. You don’t need Daniel Kahneman to tell you what is wrong with that logic. Hundreds of thousands lose their life savings every year because of this myopia.
Trust Bernie and Liz. They don’t want to fool anyone.
1
I have a question that maybe someone can answer. I am currently a senior on Medicare. In addition to the Medicare premium, which is pegged to my income, I pay for a companion plan and a Drug plan. All of his adds up. Since I have saved diligently, I have a fairly decent income stream + a small pension, which hopefully will keep me in the middle class - unless of course interest rates really do turn negative. I understand the concept that under a Medicare for All plan, some people's premiums will go down and taxes probably will go up - so a wash. For ME - as a senior - I suspect that my taxes will go up but I doubt that my Medicare premiums will go down, in fact they will probably go up so as to include all the copays and medications. Or, will a Tax on the Wealthy soak up all the costs of my companion plan and Drug plan. So as a middle class senior, how will Warren's Medicare for All Plan impact my finances??
3
Totally agree with Krugman here.
I'd like to hear why something that will certainly NOT happen in the next ten years should be your most important policy proposal when a fudgier, transitional, or less transformational version of it is actually a vote winner.
Please please explain that to me.
It's as if however much we don't like the neo-liberal version of the Democratic Party Clinton or Biden and even Obama represented, and however much we hate Trumpism (and I don't) we want to pretend that Clinton didn't win two elections after three Republican terms (and help from Perot and a slumped economy), Obama didn't win because of two dumb wars and a terrible recession and that Republican electoral power and success over the last thirty years are simply based on sand that will be swept away by vision.
I wish it were not the case. But passing healthcare legislation of such a radical nature required, say in the UK, extraordinary circumstances, WW 2 and a massive Labour majority in 1945. Creating what is effectively just a better regulated private health care system outside of Medicare with Obamacare required huge Democratic majorities and was almost annulled many times and is still under severe attack.
Warren needs to backtrack to the public option, short term price-cutting goodies, showing the path ahead for Obamacare and doing it well. Mastering reality and making uncomfortable realities into opportunities in line with one's broad ideals and plans is the sign of great leadership.
2
https://www.washingtonpost.com/opinions/2019/10/16/health-care-warren-sounded-like-student-who-hadnt-done-her-reading/
"I’m quite certain that if the [healthcare system's] problems are going to be fixed, it will be by someone who starts by carefully digging into the evidence and then works their way forward to the conclusion, rather than the other way around — by a real health-care wonk, in other words, and not just someone who plays one on TV."
1
Tax benefits as the payments they are. Pretty simple, actually. They are compensation, and it's a deal that was forged in the post WWII area to allow companies to attract and retain people coming back from the war. Lot of work to do, and we were the only economy that was still whole. Like many things, it's a matter of understanding the issue. Private insurance is subsidized via taxes by everyone, as the rest of the us have to make up for those taxes not paid.
Did trump's plan to build a wall paid for by Mexico have details? Did his plan to make drain the swamp have any infill other than bluster? Did his lock her up chant mean anything at all?
The point is that expecting someone in the candidate silo to have a plan that meets everyone's needs and appeals to voters is unrealistic and ineffective. Any plan that changes our health care insurance will require a lot more research and debate than a 30 second answer to a pundit's question.
1
Bit of a wannabe wonk here. As I was saying, we can't get there from here, given our current system. https://twitter.com/ForwardPsych/status/1176242094387671042
Sure, elimination of the for-profit third party payer system (aka "insurance") ought to be the ultimate goal. But it's voodoo math to say there won't be increased costs including to average income earners and anyone selling that is not to be believed. I look forward to her plan and especially: who are her health care system economic advisers on this?
1
Can Warren Escape the Medicare Trap ?
No.
Her approach is simple.
Walk into a bar, shout "Bartender, a round for everyone in the house...", and then say "Now, who's going to pay for it ?"
4
It would seem prudent to address how much we pay for health care before or concurrent with plans to change how we pay for health care.
I'm not interested in propping up the hugely inefficient, non-competitive and sometimes corrupt health care industry with money out of my pocket or through tax dollars.
Until we question the basic assumption that health care is appropriately provided by markets and if so how those markets could work to lower costs it seems like we're just spinning our wheels and potentially making the problem of escalating costs even worse.
2
The biggest obstacle to single payer Medicare for all is the belief that it can't happen.
We know it should happen. We know that a public private combination will mean class based medicine with the upper 20% of society having private plans and the rest of us having coverage but lessor quality.
We also know that the drug industry and the insurance industry will fight tooth and nail to retain their profits.
Finally, we know that VP Biden is right, over the next ten years Medicare for all would cost 30 trillion dollars. But what Biden neglected to say is our existing system is projected to cost 49 trillion over the same period.
We have to pay for health care regardless of the system we have. Doctors and hospitals aren't free. The question is how we pay and eventually how much we pay.
Let's start as Bernie insists with a phased program, which for the first four years will be more expensive because we would be paying the Obama Care subsidies along with Medicare. But after that we will have the leverage to begin to control costs and eventually lower them.
If Warren can match that, great. If not I'm with Bernie, and I know that for various reasons the NYTimes will never be. But that's another story.
2
Democrats need to stay focused on a single message. The current occupant of the WH is corrupt, inept, and utterly unfit. We are serious minded, responsible patrons of the public trust. We will work for you, the American people, not line our pockets or abuse our power for personal gain. And then, it won't matter which candidate is selected... it is night and day.
Forget everything else.
1
I am a 66 year old woman who went on Medicare last year; so far so good, no complaints. But what would happen to my taxes if Medicare for All were to happen? I spent many, many years paying through the nose for my and my family's private health insurance, and now that I pay Medicare and Medigap premiums, which are a lot easier on my wallet than the private ones, am I going to wind up paying more taxes to pay for others' Medicare when I didn't have to pay their private insurance premiums?
2
@Cardimom
We have low-cost employer based health care and would gladly pay thousands more in taxes if it meant that everyone in the country were covered with a high quality affordable plan.
We have to get away from "What's in it for me?" or "I've already contributed" mentality and move towards a view of helping one another and providing universal health care.
4
I wonder who all these people are who have no premiums, co-pays, or deductibles in their current private plan. Even the union members of my acquaintance are saying that their plans are no longer as generous as they used to be.
5
People are suspect of change. The Democrats need to leave employer health insurance intact and allow those who want to keep it, do so. The option should be provided for people tp opt into a public option, should they have no insurance or their company insurance is insufficient. Paying for health insurance will have to be a dual responsibility as it currently is, the employer pays a portion while the employee pays a portion. Companies that provide good health insurance and pay an overwhelming share of an employee’s cost should pay less into the government program, while a company that does not contribute at all or significantly to employee insurance should pay accordingly into the government system. As time passes, companies will look to eliminate health insurance as a benefit and have the government manage the system.
1
The point made by proponents of Medicare for All is that the nations total cost for health care will decrease. This may be true, but an overlooked issue concerns where the health costs come from. With private insurance, employers pay a large share. Most of their costs will disappear with Medicare for all. Unless they shift that savings to increased wages, workers through tax increases will pay more for health care than they currently do. Economic theory might say that the workers compensation will shift the employer health costs to higher wages, but I am not sure about reality.
2
The issue is controlling medical costs.
Let me pose two questions.
A doctor notices a symptom during a routine exam.
There is a small probability P that a serious lethal condition might be present. An expensive test that costs C could determine if the condition is present.
For what values of P and C should test be done.
A patient has a serious lethal disease.
There is a treatment that has a small probability PP that cures the disease. But treatment is expensive and costs CC.
For what values of PP and CC should treatment be given.
Who decides?
The decision must be made.
You either run test or you don't.
You either treat or you don't.
Should the insurance companies decide.
Should government.
A government option or Medicare for all means voters will force government to decide the more expensive option in each case.
Private insurance will ration and hold down costs.
I am not a doctor and don't now the answers to the questions I posed.
But the decisions must be made.
1
These are valid questions that drive a lot of our costs. The US spends a great deal on neonatal and last months or year of life. How much would we cover for a pill that kept you well for 5 years? The answer is to set a standard for what is covered based on best science. Today I was to,d Medicare would totally pay for standard lens replacements for my cataracts, but if I wanted bifocal lenses it would be $7000 out of pocket. This is rational. While some will call it “death panels” there needs to be a standard. Churches and charities could help those less able to pay for the overage if they could make the case. We have to address the fact that much is spent for little gain even if intentions are good.
The reason people on Medicare today love it is because they think they get it for free. In reality, no one compares it to the coverage they WERE getting through their private insurance plans and says "yes, Medicare is an improvement." And most people on Medicare today also find themselves having to buy supplemental policies to cover the gaps in coverage.
So tell me, how good will our substandard Medicare coverage be when we force everyone onto it and force providers to accept lower reimbursements than they get from private policies? Look up "cross-subsidies" one day and tell me what happens when providers can't defray the losses they incur from government care by making it up from the private side.
That's not to mention the stranded investment that will occur as those private insurance companies find themselves out of business. The Progressives will tell you these companies are dastardly profit-making rent-seekers, but they fail to look at their IRAs, 401ks and pension plans to see just how much of their retirement savings are invested in the Aetnas and Humanas of the world. Or how many of their neighbors work for those companies, or in the healthcare field.
You want a disaster? Force M4A down our throats and watch those unintended consequences unfold.
The real solution to affordable healthcare for all is to attack the cost side of the equation. Allow the government to negotiate drug prices. Crack down on patent abuses & limit malpractice penalties. Start there.
3
Sen. Warren: Tell me how much you are going to raise my taxes. I, like most Americans, am more than capable of determining if that increase will be offset by any "savings".
2
Really? I don’t believe you can forecast your future medical bills with certainty. No one can unless you have access to someone up there.
The probability weighted expected value of expenses discounted back to today would give you a good estimate. That is not what you are doing most likely. You, like so many others look at their current health and if they are ok they believe you are going to be ok forever and therefore your costs will be minimal and your taxes going up to pay for the probability of future catastrophes don’t enter into your radar screen. Common problem. You don’t need Daniel Kahneman to tell you what is wrong with that logic. Hundreds of thousands lose their life savings every year because of this myopia.
Trust Bernie and Liz. They don’t want to fool anyone.
3
When I turned 65 I thought that having medicare would be a panacea when compared with my private, blue cross plan. Boy was I wrong. First, Medicare has a monthly premium which must be paid and it is not insignificant. At the present time, my wife and I pay $1008 per month for medicare. Medicare only pays 80% of the doctors bills (hospitals are separate). Therefore, I must be prepared to pay the 20% or, as I did, buy a Supplemental Plan. That plan costs us an additional $500+ per month. On top of that, I have to pay an monthly premium for drug coverage (presently an additional $92 per month for the two of us). So my monthly premiums for both of us exceed $1600 per month. In addition, there is a significant deductible and copays which, if you take specialty drugs, are quite high. Tomorrow I am picking up a drug called Stelara, which I need to control psioretic arthritis and my copay will be over $1000. This on top of the taxes I pay for medicare (I still work and draw a monthly salary).
To add insult to injury, dealing with mediare to find out what is and what is not covered can be more frustrating than dealing with a private company. My wife was recently told that if she has a bone density test ordered by her doctor she may or may not have to pay more than $900 and nobody seem to be able to tell her if she will have to pay this before she takes the test.
There is no such thing as a free ride.
1
@Ira Loewy Are you paying a premium for part A? Most people don't if they have paid enough Medicare taxes. Usually people pay part B---(a bit over $130) and a supplement if they don't have Medicare Advantage and a prescription part D. So do you have enough quarters because if you don't you are not most people. I'm curious.
If you were to get plans at over 65 on the market, you would be walloped bad.
1
If Liz flips on single-payer, it shows she’s insincere and opportunistic. If Liz doesn’t flip on single-payer, it shows she’s evasive and can’t be trusted to actually fight for it in office, because she didn’t just answer questions honestly about what it entails.
It’s tough to be Liz.
Mr. Krugman is so right! Warren's dream of Medicare for All is not a viable idea and it will not be accepted by most Democrats, let alone Trump supporters.
Warren is a radical left politicians, and is punitive. If she is nominated we will get four more years of Trump.
1
She should back off the plan. Medicare For All Who Want It is a far more viable plan than kicking over a hundred million people off their current insurance. It's much more politically viable and it preserves choice. I understand the arguments for Medicare for All and they may be correct in the grand sense, but it's foolish to think we can get from here to there overnight. And you know what? I like the idea of having a choice. Who wouldn't?
2
It could be worse. She could have suggested a $30 trillion plan and then looked like a deer in the headlights when the other debaters asked her how should would pay for it.
And she could be going around saying that she is only going to charge rich people 2 cents in order to pay for everything, instead of the truth, which is 2% of their assets every year, which quickly adds up to about half.
But maybe she thinks the voters have the mental capacity of 140 characters.
2
If anyone wants to see how much this would cost, look to the North. Canada pays for its health care system via provincial taxes. The combination of national and provincial taxes Canadians pay is considerably higher than we pay in Federal and state taxes. Here is a link to see what you would pay. Pick a province and check it out.
https://www.ey.com/ca/en/services/tax/tax-calculators-2019-personal-tax
A couple of interesting points:
(1) They charge everyone, even low earners, because, of course, everyone imposes costs on the system. Plug in a low income number and see what you would pay.
(2) If you are a high earner, you will trade paying a fixed amount for insurance for a payment that increases with your income. Canada's system charges high earners much more than Americans have ever had to pay for health insurance. Their health care system is a wealth redistribution system.
2
Maybe I'm terrible mistaken, but I can't see how a plan that offers both Medicare for those that want it, and continuing private insurance for others makes any sense. You would have the private insurance plan still needing a whole slew of people still coding for cost allocations, advertising costs, executive salaries, and profits sucking money out of the system.
What people don't understand is that Medicare for all would eliminate a whole slew of costs that are now figured in already. For instance every union figures these costs in their employee dues, and in their pension costs.
Every corporation figures these costs in their employees salary costs. Workers comp has these costs in their formulas. Auto insurance has these costs figured in. I'm sure I'm missing other areas where these costs are also hidden, but the point is these costs would go away, and make up for any tax increase on the individual.
If we had a streamlined system that reduces overall costs by eliminating current private insurance costs and profits that did away the complicated system we now have, it would have to be better than what we now have.
3
@Tracy Rupp (who refers the readers to a conversation between Judy Woodruff from NPR and Bernie Sanders)
Yes, my dear, exactly correct. The fungibility of money is something that a lot of Democrats are not capable of understanding. It amazes me but Paul Krugman, a man with a very high IQ and a Nobel Prize in Economic Science does not want to understand the simple fact that decline in healthcare cost (delta c) compared to increases in taxes (delta t) to pay for the it, if equal wash out. Actually the second term will be less than the first because of all sorts of bargaining power and pricing synergies as Krugman should know, so net net Medicare for all is going to be cheaper!!! If he can prove to me otherwise with numbers I will eat my Clark Desert Boots like Werner Herzog did!
1
Dr. Krugman, what you say is obvious. God forbid Warren wins the nomination. The moderates and Independents will be terrified. They will stay home, ensuring a Trump win. What a disaster that would be!
3
While she was a distant third on the polls, she kept saying she was going to tax the rich to give to the poor. Few cared as she was far below Sanders and far far behind Biden. I am sure she did not expect to become the front runner that soon when Biden’s skeletons started to fall out of the closet.
She has since changed her tune, and she no longer sounds like Robin Hood. She now sounds like any politico out of Washington, making promises that sound like she is about to cure world wide poverty but won’t tell you how.
As usual, her problem is image. She used the illusion of being American Indian to get ahead in life, then turns out she is 99.999% white and 0.001% Amerindian. This shadow will follow her forever, because she leaned on that story so much it’s hard to put it to bed. She had the story of taxing the rich to pay for the poor, she now has to explain to rich and poor how she plans to provide what she promised, and by all appearances she has no plan.
Making the medical profession a pro bono industry will not happen, making insurance companies illegal will not happen, raising taxes to 65% like in Europe, as that is how they pay for universal medical care, will be a killer at the polls.
So vote for a crony in Washington called Biden, or vote for Warren who has no clue. Tough choice.
1
@Brian Turner (who wants -- God forbid -- Krugman to advice Warren)
Perhaps not! A Nobel Winning Economist is correct but that is true of the late Milton Friedman and Gary Becker as well. Don't confuse Nobel Prizes with progressive wisdom. Maybe if Kenneth Arrow, Gunnar Myrdal and Lawrence Klein could have pointed her in the right direction but Krugman, the trade theorist turned Hillary (and Bill) Clinton parishioner, is not a good choice. Warren is getting economic advice from active academicians (as opposed to pundits) Emmanuel Saez and Gabriel Zucman who will get the prize with Piketty soon enough (I was surprised that they didn't this year even though I really though Duflo, her husband and Kremer really deserved it too on their work on poverty). She should stick to them.
1
This article fails to mention the most important danger of universal health care. The degradation of Medicare for those that already have it is the most important point. Does anyone really believe that current medicare recipients won't end up subsidizing the new comers? I don't! Obama care was subsidized by individuals who were providing their own medical insurance. Members of professional associations like bar association used to get their health insurance through their professional associations. Now those associations can't even offer health insurance to their members. Their members were forced into a general pool and lost their group purchasing power. The new national coverage schemes will make current medicare recipients subsidize the others even though they paid a lifetime of Medicare taxes for their benefits. There are other faults with the Democrats plans such as the infusion of new affirmative action hires that will be subsidized in a new system. There have been many stories about that type of subsidies with Senator Warrens Consumer Protection Bureau. The sad truth is the Democrats can't deliver a clean plan that protects current recipients or a system based on efficiency. If universal coverage is ever to be achieved it needs to be bipartisan.
3
Access is a good point. We get all bound up in the words ‘free’ and ‘costs’ and forget about access. One way to find yourself without access is to ‘leave your network.’ Charges go drastically up and that $14k deductible will lead anyone just traveling a short distance to an insurance-induced bankruptcy.
1
I pay 20% of my premium and my employer pays 80%, which is fairly standard. I highly doubt that my employer will give me a raise for even part of that amount if they no longer face that health care cost. So if I have to pay even the equivalent of half the total premium, I will still lose out, as will millions of people in a similar situation.
2
Back in the late sixties the University of Chicago Ethics Committee undertook an examination of health care issues. They concluded that health care was too basic a need to be in the market place at all and that as long as care was tied to dollars medical decisions would be influenced by money rather than best practice. I never dreamed that government single payer would not emerge decades ago. Maybe Warren should be more flexible because of peoples misguided fears, however she is very much on track in believing that the economic structure of this country must change if the middle class is to survive at all. The unrestrained unethical capitalism we are currently living with is destroying the country and planet.
2
With such a large field of candidates, I wish they could converge on broad objectives, like universal health care, combating global warming, and working class quality of life. When a candidates gets to specific, like Warren with Medicare, it generates instant food fights, intra-party and inter-party. And the "overly specific" candidate ends up with the most bruises.
Trump got away with promising infinitely better everything and zero specifics on how he would do it. And a review of his 13,000 lies and deceptions since taking office (per Washington Post analysis and tabulation), surprisingly still keep the specifics under wraps. He's still in the running, at least from the Electoral College perspective.
1
Thanks, you read my mind.
I run a small business and when we could no longer afford to offer healthcare I felt like a big fat failure and still do. I suspect some of business still not wanting to let go is that same kind of pride.
Yet I have wondered too why small business hasn’t pressured government for a universal care package. You’d think there would be a group of small business for healthcare folks haranguing Congress like the Tea Party did because the costs you mention are even more costly for a small business both in time, money and labor.
Historically why business offered healthcare was to compete with other businesses over benefits. Now it may be to attract the top paid talent which probably could well afford to pay for their own private policy.
4
@Sheela Todd And years ago people stayed in their jobs for the healthcare even though they hated them---so all in all productivity was not the best. If we have a universal plan, then people could be more flexible, companies could be more flexible, commitment could be honest, and people could become generally more happy with themselves. Businesses would not exploit workers as much as they would no longer hold them at bay for the benefits and the ball and chain could be either loosened or tossed completely. Maybe overall, those big retail companies that pay slave wages would have to rethink about how they can attract and keep good workers or they would be hit with a chronic expendable workforce.
2
I would like to know if any of the Democratic contenders has looked into what abolishing private health insurance will do the U.S. economy. 1.5 million people are employed by private insurance companies. Many people's IRAs, 401(k)s, and other retirement plans have invested in these private companies. What happens? I'm not saying Medicare for All isn't the right path, but I want someone to tell me that they are looking at all the consequences of their actions. Also, will there be supplemental options? Every country that has a single-payer system also has the ability to supplement that system.
1
Ask folks how much they like their private insurance during the next open enrollment period when they will see the next round of modifications to their health care plans that are designed to pass more costs to employees.
Back in the late 1970's when I first started working full time, 100% of my private insurance was paid by my employer, with no co-pays or deductibles. My private insurance today, premiums for which my employer purportedly pays 75% and I pay 25%, has deductibles, co-pays and co-insurance, all of which have succeeded in increasing my out-of-pocket cost over the years. Not to mention the introduction of HMOs and healthcare networks that effectively reduced the number of choices I could make. Additionally, employers will sometimes change insurance companies in an attempt to reduce their costs, causing disruption.
Thus, I find it hard to believe that folks love their private insurance, and the fact that coverage and cost are subject to whims of their employers, so much that they will reject medicare-for-all.
6
Why does it matter what Elizabeth Warren thinks is the proper way to get to universal health coverage? The Congress makes that decision, not the president.
@J O'Kelly And from what we can see from the current administration, what the president thinks/says/does really doesn't matter. It's not like (s)he has to sign the legislation or anything.
John Delaney - remember him? - was the only Democrat who was willing to admit the dirty little secret of M4A: it requires docs to take a pay cut. Paying for M4A at current Medicare rates will be easy, but getting docs to work only for Medicare rates (instead of the rate paid by private payers now) will cause the same sort of bottlenecks one sees in other countries, but worse over time because there are so many more opportunities here for smart young men and women.
3
@ not just docs, but everyone who works in healthcare. They all will be looking for a way out.
1
The 'public option' is far and away the wisest choice.
Medicare for all, despite all of its positive traits, is a losing proposition politically. Too many people are fearful of giving up their workable policy and surrendering their health care to the government.
But, medicare as choice has less baggage, and covers additional millions of people. Nobody would have to give up anything unless they wanted to.
I suspect over time many of the Private insurance folks would move to medicare once it proves to be more efficient.
1
I don't understand how this infighting in among the Democratic candidates serves the purpose of the party or the people. My response would highlight the chasm between the 2 parties" approaches: "We're all here trying to figure out the best way to get everyone healthcare coverage (like every other large industrialized nation) while the Republicans are looking for ways to take it away."
3
Good thoughtful article, Dr Krugman.
Beyond the voters and the insurance companies, other players are involved. Pharmacy, hospitals and other medical players know their reimbursements will be reduced with a single payer plan, or so we hope!
Also a little-discussed angle is corporations' support for the current private insurance mess. One would think they would prefer to get rid of the health insurance burden, but I believe they see it as a "hold" on employees -- if we don't depend on corporations for insurance then we are more free to change jobs.
I remember a CEO coming out in support of Obamacare during its ratification fights (I think it was the CEO of Safeway). He was quickly silenced by his colleagues, and corporate America did not support Obamacare's passage.
6
I would expect massive lobbying against Medicare for All from the American Medical Association. I believe that, in this city, fewer than half of all physicians even accept Medicare patients because their reimbursement rates are considered too low. Will a new system raise rates to a rate acceptable to most doctors? If so, that will raise costs to an even more exorbitant level. Will doctors be in effect working for the government if there is no private insurance anymore?
2
There are a lot of folks -- retired military, retired civil service, retired railroad workers, retired workers on pensions with excellent medical care already AND that correctly believe they worked hard and sacrificed for those benefits. While they in principal agree with an ultimate goal of coverage for all, and perhaps right away for our fellow citizens without coverage, and also want this burden off the back of employERs (and employEEs who don't want to be "stuck" with their employer because of coverage), they are understandably very concerned about losing excellent retirement coverage for a "new" plan, particularly if they already have excellent supplemental coverage to Medicare. Any changes should allow for a prolonged transition to assure this group. Senator Sanders, I believe has said four years -- which is way too short an interval. Senator Warren should address this matter.
3
Here is another example of what is wrong with our current health care "system": I have rosacea and been using a generic sodium sulfa facial wash for years. It's always been covered. And no doubt it is pretty darn cheap to manufacture. This year, my insurer removed this basic cheapo product from its formulary. When I asked how much it was if I pay out of pocket, the pharmacy said $800. $800 for a basic inexpensive medicine that has been around forever. I can only pray that the Big Pharma people get what they truly deserve in the afterlife. BY the way, I didn't buy it.
4
@VCS One relatively simple fix to help bring down costs would be to amend the law to allow U.S. residents to fill their prescriptions online through Canadian pharmacies. Literally overnight the cost of meds like your facial wash would drop substantially.
1
If we go single payer, it will start first with the federal employees. Permanent employees have a (limited) choice to choose from. This varies from region to region. Many in central California have BCBS or Kaiser depending on which is available. There are other smaller group insurance choices available, again depending on the area.
This is true nationwide. Just the participating insurers vary.
Therefore, the federal workers logically are the first group who would be offered the single payer option, and after a predetermined time those hired "as of" a predetermined date would automatically have only that option.
This is what happened when the old retirement system was replaced with the new FERS plus Social Security and a 401K type option was created in the 1980’s.
Should the right combination of senators, representatives, and POTUS occur, this likely will be the model for states and then private employers to follow.
Now! If only we live long enough to see it.
2
First of all, if Warren really wants to sell single payer, she can do so with one simple message: No More Medical Bankruptcies.
I for one would not care whether my insurance was public, private, or some combination of the two, or whether my taxes went up (within reason), if I could be sure a medical emergency would not cost me my life savings and my house. How many people live in fear of being ruined by high medical debt? If whatever plan she proposes eliminates out-of-pocket costs or at least sets a modest cap on them, that would convince many of us to get on board.
Second, whether taxes, or total costs, would go up or not would depend on what that particular taxpayer/healthcare consumer is paying now. So for some people, such as those whose employer does not subsidize their insurance or offers only high-deductible plans, or those currently paying a lot of copays, the total would go down. Others would most likely break even, while others like me, whose employers subsidize the bulk of premiums, only have single coverage, and don't use it much, would probably end up paying more in taxes than they pay now in premiums/deductibles/copays. (I'd still consider it a good deal if I was relieved of the fear a medical crisis would cost me everything).
No matter what tax approach is used to fund M4A, in all likelihood, some would pay more, some would pay less, and others would pay about the same; it depends on what they're paying now.
1
How are we going to pay for Medicare for all?
We already are paying for it. We just aren’t getting it.
We spend $3.5 Trillion on healthcare, 17% of our economy. 70% to 100% more than any other first world country. That money comes from somewhere. We have the money.
All the money we pay to private insurance companies will be redirected to Medicare for all.
The US spends around $11,000 per person on healthcare. The other first world countries spend around $6,000 per person.
They get universal coverage. We have parts of the US with infant mortality rates of a second world country. And we are the richest industrial country GDP per capita on the planet.
The reason not to work with the health insurance industry in this country is they are the reason our health care costs are so high in the first place.
The higher the cost of healthcare, the higher their profit. And doctors and hospitals and the rest are happy to go along with it.
Warren and Sanders don’t want to work with insurance companies is because they know the insurance industry can’t be trusted to the right thing.
What’s the difference if your employer pays your healthcare premiums to a private insurer or as an employer contribution to Medicare for all.
Your paycheck is still the same. And your employer will save money.
The difference is the insurance companies will start a fear campaign.
Healthcare should be about people not about profits.
5
The fight for health care reform is like childbirth. A few years later, the pain fades and people want to do it again. The culture wars and tea party nonsense of the past decade, the political heroism that was exhibited by representatives who sacrificed their careers, the unending effort to "repeal and replace" have faded from memory, but a transition to M4A would make the last fight look easy.
A public option on top of the ACA is not a foregone conclusion. It would require significant political capital and it would receive substantial pushback from the insurance and pharma lobbies. SCOTUS would again disable key aspects of the plan. But a public option is possible, and it would be a major achievement for the next president, who might also accomplish something on immigration or child care or gun safety or election reform.
Medicare for All would be defeated in Congress and destroy the president who proposes it.
1
1. About half, 150 million Americans with health care coverage have it through their employer.
2. The other half have it through Medicare/caid, VA, Tricare, other military, and federal employees. Single payers.
3. Most private carriers - CIGNA, UHC, etc. - make most of their money on fees for administering health plans for self-insured employers. Well over half for the industry.
4. Before retirement and closing the small business I ran for a number of years, health care was the biggest expense.
Medicare for all? Wrong question. Republicans in the Senate will filibuster it unless the Democrats have the courage to end the filibuster. The Supreme Court will strike it down if it ever manages to pass. The next election swing will bring the Republican right-wing minority back into power because we failed to fix the foundation before we tried to fix the roof - in other words, our first task is to end undemocratic institutions like Gerrymandering, legalized bribery known as campaign contributions, and voter suppression aimed at minorities.
I wish Sanders and AOC supporters could get it through their thick skulls that what we need now is not the perfect policy, but a more perfect democracy.
2
I think you nailed it when you wrote of the obstacles this legislation would face even with a substantial Democratic majority. The complaints of losing ones health care surely resonate with lawmakers, and as you also wrote the transition will be (and should absolutely be) slow and methodical. It’s not going to happen so fast but hopefully the explanations as to costs will be understandable.
1
Warren should just say we'll get Mexico to pay for it.
156
@todji, now that's an idea. But aren't they supposed to pay for the border wall to protect them from Trump?
3
Nailed it. Thanks, Professor Krugman.
4
@Roger
No he did not nail anything. The only thing nailed here is his coffin as a progressive.
3
One more point that should be acknowledged and spoken to is that many seniors who receive Medicare also carry supplemental private insurance. Fear about losing that supplemental insurance, even if they also like Medicare, could be a real downer for Democrats embracing this approach. Will coverage under Medicare For All be so comprehensive that supplemental insurance won't be desired? Assuaging those fears are important issues too moreso than costs in my mind.
I was traveling in the South recently, and, there were nightly TV ads from insurance companies--not against 'Medicare for all' itself, but telling people that a public option would be no different from "medicare for all," and would take away their freedoms. The fact is, whatever Warren or anyone else proposes, and however they explain it, the moneyed interests of the current health-care/insurance bureaucracy & from the right wing media will bury them with misinformation.
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@Martin
To counter these ads trying to scare people away from changes in our health care system, we need ads that show the dysfunction in our health care system now.
There is nothing more compelling against leaving things the same than the issue of medical bankruptcy. Even the NYT has printed an example of what can happen when a person contracts a serious illness.
In the article about homelessness in today's paper, different homeless people were asked how they became homeless.
One woman, a nurse, stated that she ate through her resources after she had developed cancer and then became homeless.
As more people face medical bankruptcies the argument for leaving everything the same, without change, grows weaker.
Eventually, the bulk of people who lose all their savings caused by illness is going to become so large it can't be ignored.
25
@Martin Why not travel in the real USA? Everyone knows that southerners aren't real Americans.
7
@Martin
I’ve heard that argument ( ie that a public OPTION would somehow mess things up for those of us with private insurance who like our private insurance) from more credible sources as well, but I don’t understand the economics behind that. Is it just scaremongering, or is there any credibility to that line of reasoning?
4
This is the problem when we view healthcare from the perspective of those with power and influence and those who seek profit from it rather than those who seek and provide care .
Medicare has been in place since 1965 . We know how it works , it’s used to care for our oldest and most costly to treat citizens and it’s wildly popular .
Why in the world a progressive economist wouldn’t get behind the momentum gaining effort to expand one of the most successful social initiatives in the history of America is simply beyond me .
I suspect it’s an ongoing gripe against Bernie Sanders and frankly thats some shaky ground to stand on .
In terms of “other routes “ to universal care , that’s become shorthand for stall tactics and obfuscation to derail Single Payer MedicareForAll.
I expect that nonsense from bought of politicians and Healthcare lobbyists -not Nobel Prize winning economics columnists who should know better and certainly be more objective .
Stop looking at healthcare from the top down and start looking at it from effectiveness and utility . Our system does not work . It is expensive and immoral and it only serves the interests of rent seekers.
MedicareForAll has been shown to save Trillions while ensuring everybody in , nobody out .
Leave the false fantasy of “free market” solutions for healthcare to the GOP .
2
The Dems better get real. Warren would lose in 2020.
1
"Who Pays?" isn't the biggest question, in my opinion. "How much should medical and pharmaceutical care actually cost?" is the wild card not being discussed in any depth.
As long as somebody pays these made-up costs, the status quo will survive and become even more unsustainable. We must move from a model rooted in pricing at whatever the market will bear to one based on actual costs plus reasonable expenses to provide the services and products.
1
The current medical insurance system is a disaster. Come January, I will pay $30,000 for a family plan (my employer has no 2-person plan), plus a $3K deductible, plus co-insurance of 10% until I reach $10K out of pocket. For $43K per year I get the pleasure (NOT) of dealing with insurers, specialty pharmacies, and lots of paperwork. Oh, and guess what? My special needs child's therapies are out of network, so I don't get anything close to 100% reimbursement. This is all because insurance executives, Big Pharma and investors make big bucks.
The current system is unconscionable. Take some of the military's billions and let's fix this once and for all. The military will never miss the money. I expect to pay more in taxes, but probably less than $43K per year, and hopefully national health insurance will include dental and eyeglasses.
5
I'd get behind a candidate who put a leash on the insurance companies, taxed the rich harshly and cut 300 billion off the Pentagons budget. Some tough love with those who treat us like cash registers and we could pay for insurance.
1
Whatever Warren proposes on health care.....doesn't it have to get approved by both the House and Senate? That's a "huge" hurdle.
Medicare for all is a loser politically. People don't like the government taking things away from them. Also, Warren & Sanders still haven't said how it will be paid for.
1
Yeah, people love to pay through their noses these premiums and deductibles that's why they want the employers do it for them.
Liberals who want to improve healthcare should note 2 things. Even under the most economically sound universal health plan anywhere on the planet -
1. There is always an option to buy private plans.
2. You cant promise the same benefits to undocumented immigrants as you do to legal residents/citizens. You will create a massive magnet for people to come here solely for this and the system will implode.
May the force be with you.
1
I'll take right-wing demands to know about cost seriously when they repeal the disastrous Trump tax bill, which is going to increase the deficit by $1 trillion. Until then, they should keep quiet and practice their Russian like good traitors.
2
The whole discussion on healthcare is enough to make a person sick. We have a president in the White House who is trading appropriated funds for dirt on political opponents. We have a president who uses his private lawyer to advance the lawyer's private agenda. We don't need to pin down Warren on healthcare and she's foolish to go the single-payer route. It'll never pass - nor should it pass. Regulated private insurance works.
1
Finally. An opinion I can agree with!
1
If health care is regarded as a right and not a privilege, in that sense, it should be viewed the same way Social Security is.
The gouging taking place in the medical/health care industry is nothing short of disgraceful. Think Martin Shkreli...but he's small time. The comparable cost of health care in other countries is a fair measure of how out of whack American costs actually are. A two shot Epipen pack in the USA costs between $300.00 and $600.00 - whereas in the UK a single shot can be had for under $40.00. But jump to the top and there's Novartis with a gene therapy drug ( Zolgensma) which costs $2.1 million per patient. 500 patients added over a billion dollars to their bottom line.
Big pharma needs to be broken up - the end product of their genetic alchemy belongs not to them but the human race... Imagine a disease which threatens all human life on earth and one company has the patent on the only cure - that elevates the holder to Tolkien lore where "the absolute Satanic rebellion and evil of Morgoth and his satellite
Sauron' rule. I say, no thankyou very much!
Elizabeth Warren's plan needs to make sure that people who transition out of private insurance actually take home as salary the extra expense of their current employer-subsidized insurance.
2
Why is this so hard? Last night on PBS I watched Bernie try to explain it Judy Woodruff. It illustrates something.
I paraphrase:
Judy: "They say medicare for all will cost $34 Trillion. How would you pay for it."
Bernie: "We are already spending $54 Trillion on medical care. Even if we raise taxes we will save Americans money."
Judy: "Yes, but how will you pay for it?"
Duh!!? Can people not understand that money, whether it's via taxes or via insurance companies is still the same money! But, no! "Liberals are going to raise our taxes and - by extension - turn us into godless zombies. No Christian, your GOP is already doing that!
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@Tracy Rupp
Yes, my dear, exactly correct. The fungibility of money is something that a lot of Democrats are not capable of understanding. It amazes me but Paul Krugman, a man with a very high IQ and a Nobel Prize in Economic Science does not want to understand the simple fact that decline in healthcare cost (delta c) compared to increases in taxes (delta t) to pay for the it, if equal wash out. Actually the second term will be less than the first because of all sorts of bargaining power and pricing synergies as Krugman should know, so net net Medicare for all is going to be cheaper!!! If he can prove to me otherwise with numbers I will eat my Clark Desert Boots like Werner Herzog did!
14
@Tracy Rupp
Shout-out from a fellow Brookings-ite! Brookingsian? Anyway, I'm afraid it IS difficult for a lot of people to understand. And it lends itself to spin by the right wing. But the answer should be easy: Tax the rich and corporations so they pay their fair share. Work out the exact details later. And start with a public option. It is easier to give people something they didn't have before, than to take away something they think they like.
10
@Tracy Rupp good point, and good reply from @Blunt.
However people's horizons are very limited. They do not count the average $20,000 premiums that corporations are paying for their health care -- they only count their small share of premiums, co-pays, and out-of-pocket costs that they have to pay on their own. These small costs will not change much for the generally healthy, and their taxes will go up...how do you think that will fly?
And corporations are fine with the current mess. They must deal with insurance companies, orchestrate benefit rollouts, and pay the vast majority of the shared premiums. You would think they would be happy to offload it to the government. But employer insurance is a "hold" on the employee, stopping or slowing job changes, and I believe that is *very* important to corporations. Plus their costs are mostly tax-deductible.
I am fervently hoping Warren or Bernie or whoever can better illustrate how the costs are distributed now and in possible futures. They will need to do it in a *VERY* simple form -- can somebody do an app???
8
Does anyone other than Paul Krugman really believe that the issue of financing a healthcare program would be key to an election between Donald Trump and Elizabeth Warren. Looks like Krugman is riding one of his hobby horses to me.
The Elizabeth Warren Campaign was the first to receive my minuscule contribution - why? Senator Warren gave us the Consumer Financial Protection Act + she has plans.
It makes no sense to me to insist on doing away with private insurance out of the box. Let the U.S. put in place a plan that most migrate to instead of insisting on shutting down the insurance industry.
1
Eliminating private health insurance is the third rail of politics. The 160 million Americans may not love their plans, but they also won't give them up for something untested. If the Democrat nominee promises that, we'll be assured of 4 more years of Trump.
The best route to M4A is through a public option. For people who have private plans now, it would be self-funding. If it's as popular as the insurance companies feared when they blocked it from the ACA, free choice and marketing forces will cause it to evolve to M4A without coercion.
Americans are currently paying $3.4 trillion per year for medical care. That money can be captured to pay for M4A by funding the public option the same way that private plans are funded now.
Proposing to eliminate private health insurance companies also displays a lack of understanding of how Medicare and Medicaid work today. The government does not process those claims. They're processed by the private insurance companies under contract with the government. Do we really want the chaos that would result if the Feds built a brand new and totally inexperienced bureaucracy to replace what's already working fairly well?
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The private insurances are funded through premiums, that are too high for many, and through deductibles that prevent people to use the healthcare even if they have insurance . If public option will do the same thing, it will be definitely not better than private insurance. So, why should we have such public option?
@yulia The public option would be much less expensive since it doesn't need to make a profit, provide dividends to stockholders or pay outrageous executive compensations. That's why it would be much more popular.
I just don't understand why we cannot have Medicare for All AND private insurance. So many other countries - like England - have this. Why can't everyone have Medicare and then those who want additional insurance on top have that, too? I just don't get it...
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I had private insurance for over 45 years and ran into many problems including denial of services and large co-pay etc.. Since getting Medicare + a supplemental my problems have disappeared. If more people with Medicare speak up people with private insurance may be reassured. A major problem in some places seems to be getting doctors who refuse to take Medicare patients. This will be remedied when the MD's don't have a choice. Take Medicare patients or go out of business..
edit prior comment--
one problem with medicare for all, public option, keep or don't keep private health insurance plans is it is never fully explained. how could it be, in the spaghetti mass of of health insurance catch 22s our country has now? when i went on medicare at 65, i went to 2 long seminars to understand all of the options. A = hospital, B = doc visits, tests, C = advantage plans [which are totally private reimbursed by govt. very profitable to private sector and include A Band D] and D = drugs.Then there is the the alphabet soup of the supplemental plans: A B C D E F G...(which private companies are scaring people with because it will be phased out) i have G (the letters represent the exact benefits allowed in that category.) there are premiums, copays, & deductibles depending on which plan you choose. Advantage plans, like offered by united health care offer things medicare doesn't, but they are costly (vision, dental). I would like to see health care for all, and let the private insurers cover a %. This would work for most people, but not those without means to purchase the private part. For them, it could be covered by govt (like ACA). Cost? yes. Doable? i don't know, but simplify, cover everything and reduce private largesse would be a good start.
Unmentioned in all this: what would become of the 500,000 people employed in the health insurance industry?
Understandably, it's nobody's primary concern, but imagine that Elizabeth Warren was giving speeches about her plan to phase YOU out. You'd be wondering "what's the plan for me?"
When a car plant with a few thousand auto workers is in jeopardy, it's front page news. Politicians bend over backwards to keep them in business. Will they do the same for health insurance workers if medicare for all comes to pass?
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@Avraham --It amazes me that more people don't think of this aspect of the problem. When you add all the people who work in medical coding, all the doctors' office staff who deal with insurance, etc., I suspect we're talking about far more than 500,000 jobs. Those people are unlikely to vote for a candidate who's promising to put them out of work immediately. It's also worth considering what the effect on the economy would be if all those jobs simply disappeared, all at the same time. I hope we can get to single payer, but the ONLY sane way to do so is gradually and incrementally.
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Regardless of "the plan", keep in mind that the US Healtcare sector represents 18% of GDP. Private health insurance alone represents 6% of GDP and co-payments another 6%, so you are talking about nationalizing 8% of the US economy.
In comparison, US military spending is only 3.6% of GDP and I would argue that that is already too much money in the hands of a few decision-makers and that there is such a thing as the "industrial-military complex" which leads the government to make bad decisions. Expect the same if someone creates a juggernaut of a nationalized healthcare system (even if it's on the state-level).
Healthcare decision-making is incredibly difficult and diversity in options and decision-makers is essential to not go down the wrong path. I think some level of competition between health insurances, subject to well-set rules, is very healthy. This competition is in fact how the universal healthcare systems in Germany and France work. I think it is a misconception that the pure single payer systems in Canada and the UK are great models.
In short, regardless of your "the plan", the question is if you believe that the US Government decision-makers can take over and manage such a large and complicated part of the economy without wrecking havoc.
(P.S.: You can find the Healthcare spending data here: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html; US GDP is 19.)
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I agree in an effort to protect her left flank Warren may have trapped herself unless she can deftly pivot. Politically Medicare for all is dumb, a Medicare option is smart. Either way there needs to be transition period. I believe many people and companies (through Employer contributions) will vote with their feet and select the Medicare option with it's built in portability and what I believe will turn out to be a much better value.
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I agree that she must make a compelling case that this change is needed not only to change the arc of national spending (~18% of GDP) but individual spending. If a current family of four is spending close to $30,000 a year for health insurance, that siphons off assets that could buy a home, pay off a college loan, increase savings, etc. If that cost could be replaced with a $5000/year premium, that would be $150B/year if 30 million Americans signed up.
While I am not a big fan of government competing with private industry, the availability of a public option or expanded Medicare will provide competition where there is little to none. That too, may reduce costs in the market.
The larger issue is not Republican vs. Democrat but equality in economic opportunity. After 2008, no one on Wall St. went to jail and life returned to boom times for most of them. But thousands of ordinary citizens lost their house, their life savings, and much more.
Health insurance costs are sucking the vitality from the American economy. If someone has a bold idea of how to fix it and pay for it, count me in. If we this country can justify the bloat for the Joint Strike fighter program, it can surely come up with funding for an alternative to the current crisis.
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I'm not an economist, but it seems to me that anyone saying that we can keep the private health insurance we have, plus add a public option for those who want it, is lying. Most Americans will happily opt for free health insurance, which will crater the private market, which only survives by scamming young healthy people.
I have excellent health insurance for the first time through my job. It costs half my paycheck, and it's still bankrupting my employer. Before this job, I was uninsured for most of my adult life.
Universal coverage should be the goal, not another piecemeal approach like the ACA. We saw how that worked out - great for some, lousy for others. Bring everyone under the same umbrella. When you're done with this op-ed, stop by another NYT piece today about a million children losing Medicaid coverage: https://www.nytimes.com/2019/10/22/upshot/medicaid-uninsured-children.html?action=click&module=Top%20Stories&pgtype=Homepage My daughter was one of them, I thought she had coverage and was unpleasantly surprised.
There is no way on earth that Medicare will be free. It isn’t free now. I pay premiums every month (not to mention the six figures I paid through payroll deductions over 40-plus years).
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@Jane Grey On one hand, in my experience, many private companies in all industries, when faced with a change in the market environment, evolve. IMHO, forcing competition with a public option would FORCE them to evolve—it'd be evolve or die.
And if they didn't evolve then they'd deserve to fade away...
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Congress is quietly killing off medicare by not paying doctors enough. Everyday more and more doctors are opting out.
Yikes! The Rebublican Party is a vast collection of snake oil salesfolk preaching to a herd of sheep who believe their lies and obfuscations. No matter what Warren proposes the Fox propaganda machine will spin up a blizzard of falsehoods to deceive well meaning citizens of all persuasions. Why can't Warren just say "My goal is universal coverage and I will lead the nation on any path necessary to get to that goal." Recognizing that the Congress and the Courts have a say in the matter should not be a negative for a fair minded voter.
Just a thought: I would fund a comprehensive benefit by a tax on the rich, just because I'd tax the rich more in any case, and a sales tax.
What, a sales tax? Regressive! You bet. But for reasons that escape me, people don't mind sales taxes. Everyone contributes, nobody can say that illegal aliens are getting a break, and as the European VATs show, largely invisible to voters. Tie it to health care and it might work.
Paul Waldman of the WaPo wrote what should have been Warren's response to questioning in the last debate. It's brilliant, it's simple and it would have killed this "issue" in its crib. With all the advisors and managers and speech writers she has in her campaign, it's worrisome that they couldn't come up with an approach that a pretty smart newspaper columnist did.
https://www.washingtonpost.com/opinions/2019/10/16/what-elizabeth-warren-should-have-said-about-medicare-for-all/
Warren’s ideas are looking like a gift to Big Pharma. Maybe it would be better to create a minimum benefit that would serve as a backstop for all those who can do without all the”bells and whistles”. Call it the “Medicaid for the rest of us” option.
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Mayor Pete has staked out the correct position on health care, both for the primaries and the general election. Now Warren will have a difficult time pivoting away from single payer purity as she has hitched her campaign to a platform that has zero chance of gaining popular support. Ironically, Medicare-for-All looks less likely to provide universal health coverage than other plans based on practical considerations.
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KISS
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What nobody seems to be talking about is how painful the transition to Medicare for All will be. If you think insurance companies are not serving the public interest now just think what they'll be like when they're told they're going out of business in 4 years but would they please take really good care of folks until they turn lights off? The Democrats lost control of Congress in 2010 at least in part because they couldn't get the health exchange web site up and running on time. Just imagine what 2022 will look like when insurance companies have had some time to do all they can to make everybody miserable. The ACA is the most significant Democratic legislation to pass in the last 50 years and it has taken nearly ten years for it to take hold and become popular. Much better to build on that hard fought success with a public option than chuck it out the window and start over.
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My primary concern with the public discussion of Medicare for All is the almost complete unwillingness to discuss what happens to the current employer contributions to health insurance. Depending and varying widely upon the size and union status of the employer, many single employees have most of their health insurance paid by the employer and much of couple and family coverage paid by the employer. Many employees have only limited knowledge of the size of the employer's contribution. What happens to that employer contribution if Medicare (or really some sort of Medicaid) for All is passed? Does it simply add to corporate profits?
If nothing is done, we could end up with a situation similar to employer paid retirement with the burden of health care shifted to employees and taxpayers. When most private and some public employers did away with defined benefit plans and went to defined contribution plans, employees got shafted.
Will that happen with Medicare for All?
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I hope Krugman delves into the numbers, including an assessment of the Urban Institute's figures. If the US spends twice the industrialized-nation per capita average on health care, and single-payer is supposed to reduce the per capita cost, how would single-payer "substantially increase overall health spending"?
Likewise, last night on the PBS News Hour, Bernie Sanders claimed (a) that the present system costs c. $5 trillion a year, all told, so that his plan's cost of $3.4 trillion represents a substantial savings -- on the face of it, bringing the US much closer into line with other nations. However, he also said (b) that the average family of 4 spends $28,000 annually on health care, which is $7,000 per person; multiply that by the present population, and total annual health expenditures would amount to $2.6 trillion by that estimate.
Which number is right for current annual spending: $2.6 trillion, or $5 trillion? Whether the Sanders-Warren plan saves money truly depends on which baseline is correct.
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Using an average family of four can be misleading since children cost less and the parents of minor children tend to be on the younger side relative to the adult population overall. On the other hand, the $5 trillion figure is far higher than anything I’ve ever seen. Someone ought to ask Bernie where he is getting his figures from.
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Of all forms of insurance health insurance is the most complex. I think less than 1/100 Americans are able to understand a health insurance policy, including Medicare. Consequently, results are substituted for understanding. As a concrete example, I recently added a Medicare Advantage or supplemental insurance plan to my medicare insurance. There are more than a dozen such plans where I live. Summaries of these planes involve dozens of pages of small print . They read like a menu in a very large Chinese restaurant. They all differ from one another in small but significant ways. You would have to guesstimate your future health problems to rationally choose among them. Ergo, being happy with your health insurance is not that different than being happy with your current health care "situation". For most people "ignorance is bliss". These remarks lead me to the conclusion that Dr. Krugman is correct in his analysis. We will not get Medicare for all any time soon. The best we can hope for is inching in that direction. Sanders is beyond the pale is is uncompromising position. I'm "praying" that Warren is smart enough to avoid a knock out by hitting her head against a brick wall of opposition to all forms of private health insurance.
Medicare for all isn't really the issue. It's just a talking point, like so much of what passes through politicians lips. I'm sure that most people have their reservations about Medicare. I know I do -- Medicare is rife with fraud, and it keeps costs down by having a small and inadequate fraud-policing department. Under Medicare for all fraud may very well mushroom unless fraud containment improves.
The main issue here is not Medicare for all but the private insurance based system, which milks us all for money when we're sick and well, and fails miserably to invest in illness prevention. It causes devastating economic harm to those who hold the short straw, often leaven them bankrupt or homeless and created unmeasurable levels of anxiety for all who aren't sure what's covered by their policies.
Sanders and Warren get that we need radical change, and that protecting the health insurance companies need to be out. We need to think of them like the oil companies - something our world can no longer safely tolerate. They are obsolescent and their death knell will soon be sounded, it's only a question of by who. Sanders and Warren are the undertakers for the insurance industry. Whether it's a slow death or a fast one is important of course, but I hear their message more as their financial depredations can no longer be tolerated or negotiated. They are industry non grata, and must not be appeased for reasons of convenience. I applaud their courage. They're right.
Krugman is wrong to say the Urban Institute says Medicare for all would increase healthcare spending. It would increase government healthcare spending but it would reduce overall healthcare spending. It amazes me how all the so-called experts glaze over this very important fact.
Medicare operates much more efficiently than private insurance - 5% overhead as compared to at least 20% for private insurance.
Some estimates say that if we keep our current system it will cost 54 trillion over the next 10 years as compared to the 31 trillion claimed by the Urban Institute for Medicare for all - that is quite a substantial savings.
Krugman and others are doing us no favors by conveniently omitting that fact.
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Private insurance plans are the Achilles Heel of a proper national health system. It is very unlikely that they could ever be transformed into a non profit alternative that would work.
Elizabeth Warren is right that they need to go, but we all know that the immediate elimination of such plans would not be right for anyone. If they are to be eliminated, it must be gradual but rapid and definitive. Medicare for All must be established and a date must be set for the removal private plans that would allow current participants and investors to move away from them with as little damage as possible.
If the new system is established in such a way that a panel of experts could devise a timetable with a method of withdrawal to permit a complete transition to Medicare for All sans private insurance, there is a way of doing this. The resulting plan may well be the dreaded "socialized medicine" that has been resisted for so long, but if universal healthcare is a right and not a privilege, that is what must happen.
Call it by a different name. It happens all the time.
Paul is right her. But Warren has been right to give a non-specific answer until she had a REAL answer to give. Surely most people understand by now that Elizabeth is a COLLEGE PROFESSOR OF LAW, and that means she is going to investigate the problem before offering specifics. That is precisely what she has done with every other policy plan she has released. Have any of you read them? They’re detailed, thoughtful, and by all accounts (including Mr. Krugman) financially doable.
I’ve been saying from the beginning that Warren’s healthcare plan would be the LAST to be released. Can you guess why? Because healthcare is the MOST complicated issue to solve, meaning it takes MORE time to solve. Wait for it. I predict it will be first class, just like her other plans.
What I find ironic is that Elizabeth Warren and the other Democratic candidates are being pinned down on specifics of their healthcare proposals and what they will cost when for ten years, the GOP has talked about "repealing and replacing" the ACA without giving a single concrete proposal or cost estimate.
Once again, we seem intent on holding one side to much higher standards while giving the other side a pass.
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Public Option, Medicare for All won't make a difference outside of the ER because neither is designed to force doctors, patients, and hospitals to address America's underlying issues: obesity, tobacco. Our very profitable sick care system totally focuses on expensive drug medications and invasive therapies to address health issues that could be prevented and reversed through simple modest lifestyle changes such as eating healthy, walking 30 minutes a day, tobacco cessation, and alcohol moderation. Over 80% of our health care costs are are caused by chronic diseases associated with obesity and tobacco; yet the typical doctor's office does not help patients to lose weight or stop smoking. Anyone who thinks giving more Americans access to professional drug dealers in white coats will make a substantial positive difference in the health and well being of our society sadly mistaken.
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I support Elizabeth Warren and will vote for her if she wins the nomination. That being said, she is being stubborn and prideful about Medicare for all, and it is hurting her, just when a little humility helped a lot with her gaffes about being a Native American. There would be no harm in her saying that, upon careful reflection, she is promoting Insurance for all, meaning that people could maintain their private insurance and the federal government would expand its coverage to whoever wants and/or needs it. That is a feasible, sensible position for now. I think even Bernie's supporters could live with it in the election. If Ms. Warren can just make this one issue more aspirational than immediate and draconian, I think that the door to the White House will be swinging open for her.
I strongly favor universal healthcare coverage of some kind. But I have serious doubts that Medicare for all as defined in Sanders' bill could withstand a constitutional challenge (and it will be challenged by multiple opponents).
That bill would make it unlawful for any insurer to offer coverage that duplicates coverage under the act. It has already been established that the federal government has the authority to regulate health insurers. But from there to outlawing it entirely is a big step.
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"Keep the government out of my Medicare" is the cry of many individualistic Americans. Fighting that mindset is a Pyrrhic battle.
While Medicare for all might lower total healthcare-related costs - especially given the inefficiencies of private insurance, it wouldn't necessarily improve the overall health of the economy. That is because, as Uwe Reinhardt has pointed out, many workers at health insurance companies and in insurance departments, would be displaced.
This focus on the perfect (Medicare for all) vs the good (a public option) is enervating (mostly helpful to Trump) and distracts from the main healthcare financing elephant - we simply cannot afford to provide all the effective healthcare that is appropriate or with each medical advance will become appropriate. In other words, how do we develop a just rationing process?
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I still have a hard time getting my head around the fact that I live in a country where half the population votes gleefully for a party that doesn't think all voters deserve access to health care. What's wrong with these people?
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As some have pointed out here, Medicare, as it now stands and has stood for many decades, does not do a good job of protecting people completely. I have medicare but have found out you are far, far better protected with Medicare PLUS a supplement plan from a private company. After a certain number of days in the hospital with only Medicare, you start paying all costs. And can go bankrupts. With aging and joint disease, eye disease, and other diseases of aging, one quickly needs special protections.
Younger people might be fine with just a "Medicare for All" plan, when they are healthy, but not for older folks. Certainly other countries have solved this with better protections for the elderly in their National Health Plans?
Single payer health care coverage offered by the federal government, with no private insurance, will never come to pass. And it shouldn’t.
We need a competitive marketplace for both private insurance and for health care providers, both doctors and hospitals. Without it the level of service and the quality of care would suffer, not incrementally, but fundamentally.
Efforts should be made to revitalize Obama care and enhance the rules and regulations for private insurers. More guardrails and guidelines for private health care insurance, would strengthen the rights of patients and users alike.
The experience from countries that offer universal health care coverage offered by the state, is that both the quality and availability of services goes down. Doctors that don’t have time to see patients, overcrowded hospitals, and coverage denied, especially in mental health.
And abuse is rampant in government run health care systems. No one has any incentive to raise the alarm and workers demand more pay for less work in a never ending spiral. Who wants to care for hundreds and thousands of average citizens who pay nothing and demand everything?
Sadly, many government funded health care systems in Europe, ie. Britain and France, are now facing unchecked cost increases and dwindling revenue sources, due to an aging population and stresses on already limited resources.
@Andrew B Spoken like someone who has a vested interest in the private health insurance industry. I remember a time in our history when health insurance was given to Life Insurance customers as a loss leader. The insurance industry's solution to their diminishing life insurance market was to push health insurance after they realized how much money they could make from a growing aging population. Hence, the size and clout of the Insurance lobby has never been greater.
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We have a competition right now, what does it give us? Ridiculously high priced mediocre healthcare, that not even covering all citizens. No I don't need competition, I need affordable healthcare
As policy, the single payer model of Medicare for All is vastly superior. It is efficient (recovering hundreds of billions of dollars in administrative waste), effective (includes everyone throughout life), comprehensive (covering all essential health care services), and equitable (financed with progressive taxes based on ability to pay and thus affordable for everyone). Our private plans, even with ACA marketplaces or with a competing public option, cannot come close to that.
Yet those who understand this often slide into the argument that we can't do it because the politics are too difficult, and, by implication, we need to compromise on policy, accepting reform that achieves none of these goals.
When the policy is right and the politics are wrong, you don't change the policy, you change the politics. That begins with people having a clear understanding of the single payer Medicare for All model. If they understand it, most will demand it.
As I read the comments it becomes so clear that most people don't understand Medicare, except, maybe, those who are presently on it. I pay $135 per month out of my meager Social Security, plus 20% of all doctor's bills. My hospital bills are minimal and affordable. I buy my generic meds at Costco's mail order department in Washington State. These amounts are far below what most people have to struggle to pay health insurance companies in the US for similar coverage.
Medicare Advantage is only advantageous to the insurance company and actually weakens the Medicare system because it costs too much to support.
This plan works for me and while it may not work for everyone, it will work for the majority of us. I have both cancer and heart disease and I thrive because of traditional Medicare.
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I agree with Warren's overall view that our system is broken, in more ways than health care. $$, Citizens United, etc have robbed the majority of our Nation representation . Republicans in the Senatevote only on policies improving the lives of the top percenters. Bills passed in the House are ignored, not even debated. Polls wanting changes in gun safety laws, criminal reforms, education and healthcare, as well as infrastructure and more jobs, are also ignored. We elect these Senators and Congressman to represent ALL of us.Partisan SCOTUS has lost credibility. A revolution in thought and action is needed. Liz will have my vote.
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We will continue to have private health insurance until the day comes that the medical and pharmaceutical communities price themselves out of the private market. Higher costs will translate into less employers offering reasonable coverage. Eventually, public demand for a cost effective alternative will emerge. Until then, complacency will mean insurance methods of the past will prevail for the foreseeable future --- there is no Lyndon Johnson on the horizon.
Medicare for All is coming.
The writing is on the wall.
The people are being made poorer.
Paul if you think those with insurance they like have the numbers to win, you haven't been paying attention.
The desperation of the class war is becoming more real every day, and while the Electoral College, (R) tampering with voting rules and gerrymandering work against the sheer numbers, the tipping point is near.
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Why doesn't anybody ever ask the GOP for details about how THEY will improve our healthcare system? In 2016 when Trump promised to repeal the ACA and replace it with something cheaper and better not one journalist asked him how he was going to do it, how much will it cost, what will the new healthcare system look like? Not one. But Elizabeth Warren is expected to have the answer for everything before she even gets elected (hopefully). The double standard is staggering.
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Warren never talks about important features of universal care like mandates and minimum premiums as all Medicare recipients pay or the health care delivery crisis and shortage of doctors due high student costs and loans. When Warren was asked direct questions about funding her plan she resorted to demagoguery and talking about victims of insurance rescission by insurers. Problem is most of those cases involved preexisting conditions and were no longer applicable due to Obamacare.
All I heard was a bunch of pie in the sky promises of free health care for all which is not a well researched plan.
No, the problem is high price of healthcare, because of profit of health insurance companies and healthcare providers. Warren's plan as Sanders's offers control over these profit, that will decrease the price of healthcare overall and for many Americans.
one of the problems with medicare for all, public option, keep or don't keep private health insurance plans....is that the information is never fully explained..how could it be in the spaghetti mass of of health insurance catch 22s our country has now. when i went on medicare at 65, i went to 2, hours long seminars to understand all of the options..A B C (advantage plans) and D....the the alphabet soup of the supplemental plans, A B C D E F (which private companies are scaring people with because it will be phased out) and G...i have G (i don't recall all the letters but they represent the exact benefits allowed in that category. there are premiums, copays, deductibles, etc depending on which of the plans you choose. the advantage plans, like the one offered by united health care offers things traditional medicare does not, but they still cost (vision, dental) and when i have looked at them, they are costly. SO, the road i would like to see would be, health care for all, and let the private insurers cover a %...but forget all of the spaghetti and EVERYTHING is covered. This would work for most people, but not those without means to purchase the private part...for them, it could be covered by govt. cost? yes. Doable? i don't know, but simplify and reduce private largesse would be a good start.
One problem with the "Medicare for All" proposal which is seldom touched upon is the incorrect belief that "Medicare for All "would translate into "Health Care for All. "Providers need not participate in Medicare. Some providers never participated in Medicare. Many who participated in Medicare have opted out of participating in Medicare in recent years. Some do not accept new patients who are insured under Medicare.
Proponents of Medicare for All seem to be under the misguided impression that M.D.s are going to agree to have their incomes slashed substantially. The same individuals who would never agree to have their own incomes slashed, who have not sacrificed their 20s and early 30s towards becoming M.Ds., and do not have hundreds of thousands of dollars in medical school loans to pay off, expect the M.Ds. who have made these sacrifices and have incurred tremendous debt to agree to that which they would not.
The reality is that those M.D.s who participate in Medicare will be forced to opt out en masse if " Medicare for All" is enacted .They are subsidizing the low Medicare reimbursements with the higher private insurance reimbursements in order to stay afloat.
I would recommend that proponents for "Medicare for All" interview providers, and study the financial reality, in addition to the financial costs and other important realities that Mr. Krugman has addressed.
After all, the goal is Health CARE for All, not "Health Coverage for All."
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They will, otherwise they will have no patients and no way to pay their debt. Moreover, they can not even move to other countries, because there their salary will less not more. Right now we are forced to pay what they ask, with M4A they will be forced to accept what we can afford. I like that situation more
I wouldn't want anyone to go without healthcare or medical treatment ever! However, journalists AND her fellow democratic candidates are "badgering" Ms. Warren with the same question of how this is going to get paid for and, ultimately, how much will taxes go up. They are, of course, being entirely disingenuous as they know the only answer is higher taxes. The reality is that a country the size of the US (with it's 5000+ private insurance companies) is not going to embrace anything approaching medicare for all. If Ms. Warren wants insurance for those who cannot afford it, then perhaps she will have to sacrifice one of her other fantastic proposals (like wiping out student debt) to pay for it. Any increase in taxes for the middle class (regardless if it's smaller than that of the rich), is going to be seen as stealing the few "crumbs" (Warren's word) we've been given.
Medicare for All isn't going to pass anytime soon, and maybe never. For people who work for a large employer, or are on Medicare or Medicaid now, replacing private health insurance with an expanded government run Medicare plan isn't particularly compelling. Most are very wary of the gap between political promises and the reality. The ACA is a case in point.
What everyone does care more about is the cost of healthcare. Implementing things like allowing Medicare to negotiate drug prices, and passing those rates on to private insurers as well, would save hundreds of billions of dollars over ten years. Similarly, implementing tort reform would eliminate a lot of the physician overhead (i.e. malpractice insurance premiums) and further reduce costs.
Beyond that, there are many other ways to reduce costs, including experimenting with fee for outcome, rather than fee for service, pricing.
Combining these cost saving ideas, along with providing a public Medicare option, as Amy Klobuchar has proposed, is a much more sensible - and doable - solution if Democrats win the Presidency and both Houses of Congress.
Warren's plan, and Sanders', simply isn't going to pass. That's the reality. And putting all the time, money and effort into a Medicare for All plan that doesn't pass is a wasted opportunity to get a real solution passed, and not just talk about some grand plan that never materializes and wastes political capital.
Although Medicare negotiation is good start, but it will affect the prices of drug for Medicare patient, not for the rest of the population. So, effect will be minimum. Fee for outcome may be a good idea, but it is difficult for me how it will be implemented considering uncertain nature of outcome even when the best care given. Public option could be great, but it needs to be defined ( who covers what, and for how much), it also need to clarify how it will be paid, especially if it will be good, and everybody wants to get this option. Amy is heavy on critics of other, but really light on the detail of her own proposal.
I hope Ms Warren rethinks her stance. I am a serious liberal but I have a hard time swallowing the idea that it is a viable option to eliminate the current employer coverage. Sadly this seems to be a good way for the democrats to lose the election.
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@NYT Reader
Dogmatism of all kinds is bad for you. The dogma that employer coverage is good for you is just that. I yet have to hear from anyone who likes his employer provided INSURANCE COMPANY as opposed to the medical care he/she receives and where he/she receives it. The US government manages the largest army, navy, air force and national guard in the world wonderfully. It manages NASA and NIH equally brilliantly. So why wouldn't they be able to manage health insurance for everyone well? If I "blindfolded" you and let you choose between employee provided Private Insurance and Medicare for all will you know the difference? No is the honest answer. Ask around then to people who have Medicare (without the Advantage add-on) and see what they say. Do you even know what the statistics are for that answer? Look them up, they are a Google search away. NYT Readers should be a little less dogmatic than what you are projecting.
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The objective all Democrats want to achieve is a system that provides affordable, accessible, effective health care for every American from prenatal to hospice. But there's more than one route to that objective. Why frighten people when it isn't necessary? We can't create such a system if we don't win and we won't win if we aren't able to re-assure the voters that we're not taking something away from them and charging them more in taxes at the same time. Let's start with Obamacare as a foundation, fix its problems, making it cheaper and more available, and add a public option that can compete with the private sector. This is especially important for the uninsured and those dependent upon job-related plans, that they will lose if they become unemployed. We can call it Obamacare 2.0 with more to come. As people begin to get used to it, and grow to like it, (as has been happening with current Obamacare) many, perhaps most, will be induced to drop some or all of their private insurance and the public will expand. We can get there, Democrats, but not if we lose this election, because if we do, there won't be any more.
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To be clear: I support Medicare AVAILABLE to all. And if that plan were to outcompete private insurance over time, so be it.
But I also believe that competition over time—regardless of private vs. public ownership—is the best avenue to deliver service and costs (especially with the Medicare back-stop, and with private insurers having to compete with Medicare available for all).
That said: I'm not even sure that outlawing private insurance would pass constitutional muster. On what basis can you tell people they CAN'T buy insurance? Also, I am told that the social democracies in Europe that have national health services ALSO have private insurance, as well—under the Warren/Sanders approach, we'd become the only major nation WITHOUT a private insurance industry.
Secondly—what is Senator Warren's plan for dealing with the immediate economic impacts of an entire industry being unemployed? According to Statista, the industry employed 2.66 million people. If every job supports about 3, that's 8 million jobs. On total employment of 129 million, that's more than 5 percentage points. So even taking 3.5% unemployment as a starting point, that's an instant jump to 8.5%. A jump that big that fast? Great Depression territory.
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I fear the plan for everything Warren has been caught with no real plan for Medicare for All. Her promise not to raises taxes on the middle class has caught up to her and has left her espoused . Her saying she will put out her plan in a few weeks really means she does not actually have a plan today. I think in the love fest masquerading as a debate no one held Warren to task about her Medicare for for all plan. What Congress is going to pass a plan that will only tax the rich to pay for plan? People who like their plans is going t o vote to take away their plans? In one debate she said no one like their plans . Their are many people who love their plans. Warren has no room to be disingenuous about anything in light of her unforced errors. I really wish she could pivot to fixing Obamacare . I fear she has painted herself into a corner.Ii really think Trump would love to run against Warren. I was a ardent supporter of Joe Biden but have come to the sad realization that he just doesn’t have the it him to beat Trump. I really hope Amy Klobuchar gets a real look because I think she is the only one not selling pipe dreams. I also think she has the grit to take on the bully.
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People “like” their employer provided health care until they need it. I have yet to hear a story of someone receiving medical attention and “liking” how their insurance worked.
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If I am 45 years old, employed, and pay payroll taxes which includes the Medicare FICA tax. If I 'm forced to enroll in Medicare and pay that premium, do I continue to pay the FICA tax for Medicare?
@dbl06 How much do you pay for your medical insurance coverage now?
Have you been in the hospital recently? What do you think of the probability of being hit by a car, or having a bee sting if you are allergic?
I don't want to be alarmist, but things do happen. The longer you live, the higher the probability that bad things will happen to you.
Sure, a combination of subsidies and regulation is theoretically possibly. Unfortunately that is being tried right now and our health insurers have responded with ingenious bad faith and practiced manipulation. Single Payer is a litmus test. Those who support single payer are willing to take on the vested interests of a monopolistic industry to win something good for us all. Those who oppose it are willing to take on monetary and human costs in order to insure the continuance of a corrupt and inefficient monopoly.
M4A is essentially about trusting the government. Trust is what makes this a difficult issue. The government is not consistent when it comes to honoring pledges made to Americans by past governments. In my lifetime, what I've seen is the candidates who run for office by campaigning on tearing down or 'fixing' or even eliminating whatever benefits have accrued to the individual by previous mandate.
So, abandon the health insurance you pay for is asking a lot of people when they suspect, like Obamacare, the next bunch of 'electeds' will try o eliminate it.
Really just think of how much time Republicans have spent trying to deconstruct the ACA without offering something substantial to replace it and you'll understand why single-payer health insurance is too risky to be real to most voters.
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Excellent point. I think government distrust is at an all time high, for some good reasons I might add. Selling a monolithic, all government policy might not work for Democrats. As a lifelong Democrat, it doesn’t even appeal to me. In view of recent draconian vaccine mandates that constantly enforce a larger liability-free vaccine schedule with little open debate, I think the Dems should bow out of more big brother moves. They are no longer being seen as champions of democracy, more like the party of Big Pharma.
For all the reasons everyone has mentioned this is the issue on the democratic debating table that is most likely to lose the election. Took two years of democrats fighting among themselves to get the ACA. That fight contributed to them losing congressional control in next election. Obama could never get any major legislation past in next six years. Democratic primary voters better wise up.
One way out would be to endorse Medicare for all as Medicare is currently constructed: The federal government pays for hospitalization. Employers, individuals and state Medicaid plans would purchase gap coverage seniors buy now that would cover office visits etc. at a fraction of the cost they are paying now. Yes, taxes would go up but so would earnings and wages. And the country would finally be a position get health care costs under control.
All Warren would have had to do is offer a medicare for all public option and tell people they can keep their private health care. Of course, over time, the private insurance companies would not be able to compete with this and more and more people would enroll in "Medicare for All" and the private companies would lose people to Medicare for All. My problem with Warren is that she does not understand this and the Republicans will pillory her for allegedly trying to take away their employer based health care, which will hurt her politically because most of the American public is not smart enough to realize the scams pulled on them by the private health care sector.
Would be interested to know if the cost roll-up will include the retirement decisions of the 55-65 age bracket. My wife and I would love to retire at 55 and could probably save enough if we where not looking at $40k/year for medical coverage. If enough people are in the same situation, there could be a measurable drop in tax revenue from early retirements?
Why, in this important debate, are the people who actually provide healthcare - hospital administrators, doctors, nurses, group-plan physicians, public health officials, pharmacists, therapists - virtually left out? I haven't heard their views mentioned by any of the Democratic candidates, not to mention most of the commenters in this space. Surely, after more than half a century's experience with Medicare and Medicaid and nearly a decade with Obamacare, those in the trenches have a lot to tell us about what works well and not so well, why costs go up and what could bring them down.
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What's wrong with Medicare?....it's too democratic.
Those at the top end deplore democracy.
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I would love to have Dr. Krugman put out a paper on how an economist would arrange finances for health care. How would the billions that are paid by employer health plans be handled? What affect does the fact that we don't pay income tax on employer health care figure in? The real sad fact of the health care debate is that unless Moscow Mitch is defeated health care will not improve.
The problem with any insurance; you don’t know what you have until you use it. I had healthcare coverage provided by my employer, at the time the 5th largest corporation in the country. Besides a monthly premium, it also had a $2100 stop-loss. I was put on a medical disability retirement in 1997 and started coverage with Medicare in 1999. On Medicare, I’ve had a hip replacement, complex spine surgery, radiological treatment for metastatic adenocarcinoma of the prostate and a myriad of other care resulting from 65 years with a degenerative bone disease. The only time I’ve had care deemed medically needed denied was under the employer policy. Current Medicare is far from free. You’ve paid for parts of it throughout a working career, namely Part A. Part B has a monthly premium of $135.50. Part D a monthly premium roughly $33 per month. In addition, I pour $230/month into a capitalist style Medigap policy. By the way, if “Medicare for All” doesn’t have all these parts, it’s not Medicare.
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Make insurance companies non-profits and we can work from there professor.
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@sapere aude
Actually the way it used to be before Nixon signed an executive order allowing for profit health insurance.
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A serious question needs to be answered by the advocates of Medicare for all and that is will the US retirees under present Medicare be grandfathered or thrown in with the rest of the population. The 80% coverage of cost and short term hospitalization is readily affordable to most of the roughly 58 million American covered by Medicare. It is affordable because they paid into the Medicare fund for their entire working life of 30-40 years. Any plan in the future must account for these funds to be applied to those who paid into the Medicare trust. There would serious political consequences if this were to be changed.
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We currently have a president who had no coherent policy to offer during his campaign. This reveals a populace who cares more about talking points and wider platitudes than details.
To berate Warren for lack of details shows a lack of comprehension in basic negotiation tactics. She can tack hard left knowing full well that politics will not make it possible. Meaning once elected, she will ultimately reach a compromise somewhere in the center. Like Obamacare.
To ask her to get real and start negotiations in the middle is to give ground to the far right and their dedicated propaganda channel that the center is somewhere in far right field. She has more to gain by holding steady than capitulating to the bumper-sticker logic of the right.
@Tiki Archambeau One little flaw in your logic: She will never get elected by tacking hard left.
@Carl Yaffe Not a flaw in the least. The flaw is in playing to centrists. Just look at Kerry in 2004. And Hillary in 2016.
@Tiki Archambeau The problem in both of those cases was not that they were/played to centrists, but that they made serious errors in running their campaigns having nothing to do with ideology.
At least for the foreseeable future, I stand by my prediction.
I must say, most people cling to their work policies and avoid Medicare for as long as they can. Our family's loss of insurance from work would create great difficulties.
If people don't have insurance, Medicare should be there. Hands off our well paying private plans.
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@K.M, Case in point, my brother-in-law is a college professor at a community college. One of his prescriptions cost $3000/mo. He has to continue working to keep his health insurance which pays the $3000. Medicare won't pay for it.
@dbl06
I have rheumatoid arthritis and require a monthly infusion of Actemra which costs $3000 a month. My Medicare and TriCare (for military retirees and their spouses) pays every penny of it. It costs me $100/month to sign up for TriCare.
I can't see how increasing the income tax to pay for Medicare for all would be fair. The wealthy can hire tax experts to manipulate and thus lower their taxes. It is conceivable that some could get free Medicare if taxes could be reduced to 0. So, it seems that the tax to pay for MFA would have to be a flat tax where everyone pays the same. Am I wrong or do I just need enlightenment?
Something that needs more discussion is comprehensive versus catastrophic coverage.
Part of our dysfunctional marketplace is the comprehensive coverage.
Using health insurance for preventative care and minor illness is a lot like requiring home insurance for a visit to Home Depot or Lowe's!
Imagine trying to decide if a certain brand of screwdriver was on your insurance formulary!
Or, what if you had to buy gas (or a car wash!) through your auto insurance?
Absurd, you say. But that's what comprehensive health insurance does.
If health insurance was for catastrophic cases only, couldn't we have a normal market for "office visit" healthcare -- one where doctors compete on price and service? And where the consumer is aware of the cost?
Eliminating insurance claims for non-catastrophic engagements would remove a lot of "middleman" waste out of the system right off the bat.
Of course, one issue is that what is catastrophic for a low income household is an office visit.
But that is where public services could kick in (today, it's called Medicaid).
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However inefficient private health insurance might be, it's not going to be done away with all at once-- Obamacare was, after all, a compromise because of Congress. But we need a system that creates public clinics, hospitals, labs, pharmacies, rehabs, mental health facilities. The 19 yr old addict needs a place to go, as does the 40 yr old mentally ill woman I encountered yesterday who had nothing but her clothes and a blanket-- no food, water, or even shoes. So many Americans don't have company provided health plans, or if they do, they aren't very good. After having dealt with the INS, IRS, DMV, Social Security, and the military, I have no illusions of anything run by the state. But for-profit healthcare should become the exception, not the rule.
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Remember the comment of China’s leader Deng Xiaoping, when his reforms were criticized for not being communist: “it doesn’t matter if a cat is black or white as long as it catches mice.”
Those democrats who insist on eliminating private insurance are focusing on the color of the cat. Eliminating private insurance isn’t a proper goal. Health care is the goal. It’s the same kind of error that conservative ideologues make In demanding an entirely private sector insurance system. Their goal is less government, not better health.
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I feel a kind of battle fatigue due to Trump, and the idea of dismantling the entire healthcare system doesn’t appeal to me. It sounds like fights and chaos. Perhaps for a good cause but as a voter, this concerns me. I think a public option, guaranteed coverage of preexisting conditions, and lowering of drug prices would more likely carry the day. I also feel constant focus on healthcare seems to crowd out other economic and environmental discussions. To win an election, you need to sell it. Why not talk about lead in the water, fracking chemicals and mercury in the environment and other issues tied to healthcare costs. The endless focus on premiums, deductibles, etc seems too narrow, also boring.
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Why is all the focus on Senator Warren's specific plan? Why is nobody pressuring Bernie Sanders for specifics?
"Of course, it's a trap for Warren to get specific"
Isn't it strange that the Dems put out all these "plans" that they will no doubt try to implement with various degrees of success, yet the guy in the White House didn't put out any plans for anything but CLAIMED he had "secret" plans for everything, all being the best, the greatest, the most amazing plans the world would ever see.
Yet NO such "plans" for ANYTHING have been forthcoming...because NONE EVER EXISTED.
The guy in the WH lied about everything and got elected. The Dems tell what they want to do and everyone frets they won't get elected.
What is wrong with our country, or maybe ask, what is wrong with some of our voters?!?!?
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@Joe Rock bottom What's wrong with many of our voters is that they're looking for easy answers to complicated problems. Answers like "Medicare for All".
Thank goodness she can escape the
Mediocre trap, that's what I'm looking for
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Thanks for this thoughtful piece Mr. Krugman and for spelling "bated" as in "bated breath" correctly.
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This is Warren's Achilles heel. The people with insurance paid through their employers will be the lost votes that she needs to win. Most thinking people want Trump out, but this is a security issue.
Among the things that makes me absolutely gazongas about some of today’s “leftists,” is that they have a first-rate, popular platform on which to build better—the PPACA, whose passing was a genuine genius-level miracle—and because they’re ignorant and lost in fantasy, they won’t take the thing as the solid foundation for building that it is.
It is absolutely insane, the delusions of crowds at its finest, and it may just get Trump re-elected.
Yes she can, Yes we can afford a good health plan. No, it cannot be explained simply in a sound bite. Its a complicated explanation with lots of numbers and most folks do not listen long enough to actually see the facts. She will have to overcome "communists" etc. which is a one word simple explanation.
To illustrate see letsbeawarefolks.blogspot.com-yes we can afford universal health care for the facts and numbers. it is real, will explain but you have to spend some time understanding.
Please do not conflate universal healthcare with Medicare for All
Shame on Professor Krugman for peddling that outrageously dishonest Urban Institute study as reputable. That study added up the premiums that would be paid to the government for public healthcare, but neglected to compensate for the reductions in price from the elimination of private premiums.
I can't express how disappointed I am with Professor Krugman for peddling this junk study. He knows it's garbage.
Shame on him.
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Dr Krugman, Lawrence Tribe is advising Nancy Pelosi on all things impeachment (or so I have read). Maybe you could offer your services to Elizabeth Warren as a Nobel award winning economist?
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@Brian Turner
Perhaps not! A Nobel Winning Economist is correct but that is true of the late Milton Friedman and Gary Becker as well. Don't confuse Nobel Prizes with progressive wisdom. Maybe if Kenneth Arrow, Gunnar Myrdal and Lawrence Klein could have pointed her in the right direction but Krugman, the trade theorist turned Hillary (and Bill) Clinton parishioner, is not a good choice. Warren is getting economic advice from active academicians (as opposed to pundits) Emmanuel Saez and Gabriel Zucman who will get the prize with Piketty soon enough (I was surprised that they didn't this year even though I really though Duflo, her husband and Kremer really deserved it too on their work on poverty). She should stick to them.
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Staggering lack of information that could be found by watching YouTube comedians doing news out of their garage. YouTube comments have more relevant facts than this article. Not surprised but still shocking. Maybe list the total cost of our current system and the predicted cost of Medicare for All? Nah, that would just show how Medicare for all saves two TRILLION dollars in that time frame. But, nah. Let's write and print more articles about how radical and expensive it is. What a joke. Shame.
Thanks to St. Ronnie and good ol' Grover Norquist and his pledge--now signed by 95% of GOP legislators--Warren is in a very tough spot. If she, or any politician, should dare utter the dreaded "T" word, winning an election instantaneously would become impossible.
"Your taxes will go up by $5,000, but you'll save 20K in premiums and much more in out-of-pocket costs"?? Way too sophisticated (and elitist!) for American voters. Nobody likes the gummint stealing their money. But it's fine if Aetna does it. Because...liberty.
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Warren is what the doctor ordered?!
Excellent essay, Professor.
I am glad to see a few people, Sanders included, who have pointed out that eliminating the premium is going to be a major cost savings. I like to think of health insurance premiums as "taxation without representation"; a meme that has worked before to some good results.
I am also glad to see you pointing out that people don't really love their insurance, and they especially don't love their health insurance companies. I'm sure most of US would rather not have to fight with them for the coverage we have been promised.
And as democrats, this year especially, we cannot let the perfect be the destroyer of the good.
There is going to be some big money from the 1% spent to keep Elizabeth Warren from getting the nomination and the presidency. She is right that now is a good time to go bold; but people are rightly scared about a whole lot of issues right now, so that boldness had better come with some cold hard facts.
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Warren's insistence on her health care plan, which I vehemently oppose, offers another obstacle to her questionable electability. Apparently she does not listen to, nor understand, other peoples' opinions.
I heard Warren say, "No one likes their health coverage". Elizabeth, I love my health coverage, so please listen to me.
Common sense dictates that we keep those things that are working in place. We then figure out how to improve those things that aren't working. We don't trash everything and start over.
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If the Affordable care Act (ACA aka Obama Care) was not implemented all at one time then why would anybody expect Medicare for All would be implemented all on one day? Obviously, it will take a decade or so to get implemented fully and for all the fine tuning to take place.
Urban Institute, I don't care if it is Left or Right, over estimated Medicare for All costs. Presently, the government already spends 800 billion on Medicare, 624 billion on Medicaid, 149 billion on other health insurance (like Veterans), totaling $1,573 billion dollars per year. Add to this, private insurance premiums (1278 billion), Out of pocket expenses (397 billion), and Other Third Party Payers (576 billion) totaling 2,250 billion per year. Combined total cost for Health care spent currently (Status quo) is $3,823 Billion Dollars. Even Rand Institute's estimate for Medicare for All is lower than that of the Urban Institute because UI used much higher hospital costs and overly generous (comprehensive health coverage) health plan and no out of pocket costs and no third party insurance. Correct estimates indicate that the total cost of Medicare for All would be about $3,283 billions. That would save about 600 billion annually.
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I am a big fan of Elizabeth Warren, her politics and many of her plans to achieve a more democratic republic. And I have been around the block a few times and know the GOP propaganda machine (Fox News) will pull out all the stops to spin, lie and obfuscate the facts of how many of these Warren plans and policies will improve the lives of the blue-collar workers.
May I suggest Senator Warren begin moderating herself a bit more? Please recognize that while few dedicated Trump voters are likely to vote for any Democratic candidate, a majority of the moderates and even a few old-school Republicans can be won over if the Dems recognize Medicare for All and Free College for All are financially unattainable even if they may be good policy.
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@GTM Problem for the Dems is that both are probably attainable. Abandoning the goal would be a mistake.
10
@GTM you're right,lts just give up and admit defeat,so much for living in the best country in the world.
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@GTM This may be good advice, but this isn't who Elizabeth Warren is.
You're asking Warren to be Amy Klobuchar, who is the person that can win moderates and independents, because she has in the past - even some Trump voters.
Warren isn't going to do that. She could beat Trump, but it would be a narrow victory and far from a mandate. Klobuchar could win more substantially if Dems embraced her more moderate policies.
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Very good points, Dr. Krugman. And, yes, Senator Warren surely knows all of these things. Let's hope that her and her team's short term finesse is up to producing a plan that's at least minimally credible, but with political wriggle room. The whole issue starts over (except for people's accumulated prejudices) after the beginning of a Warren Administration.
Why not learn what other countries have done to solve health care coverage - take out successful elements of it - and apply it here !? After all, countries like the UK, Italy, ISRAEL, Canada- the list is really long and impressive in its solutions- are not totally dumb, or clueless when it comes
To solving complex problems successfully.
After all, it’s not reinventing the wheel we’re talking about,
Only learning well what has been done successfully elsewhere-
And apply it here- at least as successfully.
Surely it’ll take to admit we’re really not the greatest/ smartest, by hey, we may still do something REALLY IMPORTANT for ourselves.
I hope the likes of mayor Pete will consider that reasonable option.
1
The whole debate is so sad. There is plenty of money but no political will to properly redistribute it.
I turned 65 and received my Medicare card this year. I still have private insurance for supplemental.
I cannot describe how utterly LIBERATING it is to have health insurance that isn't connected to employment. Medicare is my right as a 65-year-old U.S. citizen! Fantastic!
I want this for EVERYONE, from birth. Just think of the entrepreneurial creativity that could be unleashed. Like college debt, our health system is a ball and chain holding back future productivity and wealth-building.
But the conversion must be thoughtful, well-planned, and 10 years in the making, so as not to crater health financial markets. We can make shareholders whole, dump the CEOs, and hire the employees to work for Medicare. It can be done!
1470
Thanks for sharing your story. More people need to hear it. I totally agree.
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@Jules
The problem with Medicare for all is that it can be demagogued very easily and could get some important voters groups scared enough and oppose it. Given the high level of ignorance in our country, and broad coordination of right wing propaganda, evangelical outlets and russian propaganda, the confusion among the voters will be very real.
Democrats do not have propaganda arm that could counteract this.
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@Max There are about 140 million Americans on some kind of Single Payer US Government health program (Medicare, Medicaid, and VA). It shouldn't take long to convert.
Because of Medicare, I am healthier than I was when I was 65; 19 years ago. Medicare is good for your health. I agree with you 100%.
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Since 1976 the Hyde Amendment has denied women covered by Medicaid their right to abortion unless they can prove they were raped (try that sometime) or that their pregnancy is life-threatening. Besides inflating the ease with which creating a new massive healthcare bureaucracy could be established and administered, not one advocate of MFA will acknowledge that any federally funded program is subject to rationing/denials like Hyde. We need private insurance to protect women and others, like trans Americans, whose healthcare is subject to political denials. Why won't Warren and the rest admit this? Instead they wave off Hyde, ignore the need for funding med schools, residencies, medical education and pretend that federal programs are perfect. They are not.
After spending the bulk of my career in two arenas, clinical medicine in the US and global health around the world, I have concluded that we Americans need massive group therapy to address our conflicted emotions.
Why?
1) Most people hate their insurance company, and every one is worried about loosing their insurance company's favor.
2) Almost everyone on Medicare likes having Medicare. Our Vets appreciate the VA.
3) Most informed Americans understand that the rest of the developed world, with fewer resources than the US, has achieved universal healthcare coverage, with integration of their public health and healthcare systems, to achieve better healthcare outcomes at a much lower cost.
4) The citizens of the richest, most powerful country in history, do not believe they can achieve single payor healthcare in spite of all evidence to the contrary.
5) Our citizens die from preventable causes, while going bankrupt due to healthcare costs, while being convinced they have the "best healthcare in the world".
6) The rest of the world thinks we Americans are crazy. They are correct.
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@Pediatric neurologist
Very well put and exactly why in Canada we just cannot understand what is taking you so long to see the light. Taking an entire layer of profit for insurance companies out of the equation and sharing healthcare costs among all citizens will make healthcare more affordable and universally accessible. Every American should have to sit and read your 6 point list and think about it for 15 minutes every day until your collective will finally swings decisively in that direction.
42
@Pediatric neurologist
Excellent post, thank you.
21
@Pediatric neurologist
Great post and exactly right. In addition to being crazy, though, Americans are also poorly informed and frustratingly resistant to (or incapable of?) becoming informed. Health insurance is a very complex topic. For the voters to make informed (and therefore good) choices, they need to invest the time and effort in educating themselves—and be critical evaluators of the information they receive. Instead Americans let themselves be manipulated by self-interested fear mongers.
One hopes that Warren is not just preparing an effective plan, but also an effective education campaign. Because if we continue to try to set policy by soundbite, our country is doomed.
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Bruce Rozenblit
Kansas City, MO3h ago
Times Pick
".... Many people want to say they "chose" something as opposed that they have been mandated into something, no matter how good it is. "
Thanks, that is an interesting point. Personally I'm good with anything that removes the necessity of employers from healthcare so we don't care what job we have. All the "experiments" have been done in other countries, from full government involvement to full private insurance and facilities with just strong government regulation. Fine with me either way.
The cost people are mainly concerned about is the cost to them. Will they get more or less than they currently receive for their money?
I know very few people here believe this but today a good number of people are covered by very good policies which include the freedom to see a specialist without pre-approval as well as schedule various surgeries in the same manner. Does the employer contribute a chunk of cash towards the premium? Sure they do but it's towards that particular groups' coverage. Will those same employees receive the same level of care for the price they pay in retirement? Maybe.
But someone is going to take a haircut in either Warren's or Sanders' scheme. Profits might be out of the picture but budgets and resource scheduling remain.
Telling folks they should accept something less will not be politically popular with certain segments of the population. Making fun of them, calling them liars, belittling them, telling them stories of the minimal but sufficient care one received somewhere else in the world or telling them they're wrong will not change that picture.
And they're valid concerns.
1
One problem that all candidates have with their health care plans is due to the fact that so many apparently do not consider health care as a right. Seems to me that is the first battle to be won.
The most reasonable approach, in the opinion of this reader, is to provide a public option for all those that already have coverage from an employer--that is, require all employers to offer a public option. Employers--based on my experience as an employee provided coverage by my employer--already offer multiple plans from which employee-provided plans employees could choose from.
1
you're right. i like warren, but right now i support amy klobuchar. warren's "medicare for all" mantra underscores the perception of her as an ivy league academic without practical grounding.
and, she also needs an explanation for how to account for all those medicare premiums (taxes) people have been paying for their entire careers to subsidize their health care coverage at 65--vs. allowing everyone to take advantage of the same insurance without the pre-payments.
1
Here we go again, as the Times did last cycle, it will pull the rug out from under the real Democrats and loose the primary to Biden, possibly loosing the election to Trump. As Sanders and Warren disappear from the corporatist controlled media replicating their shutout of Sanders last time.
The primary weapon working to beat down on what a large majority of Americans want is to identify them and it as far left and radical left. I am once again so disappointed in the Times and the Post.
If MFA is so radical why is it the choice of every advanced economy?
@The Iconoclast
MFA is emphatically NOT the choice of any other country. They all permit private insurance to co-exist, even Canada and the UK. Bernie’s plan is way out in left field compared to the OECD nations’.
Like most Medicare recipients, I am relieved to have reasonably priced health insurance with good coverage. I have Medicare Advantage plan, a partnership between Medicare and private insurance--in this case United Healthcare. I have to report it is excellent! No premium above what is taken out of my SS; $5 co-pay to docs in-network (zero co-pay next year);ability to see out-of-network docs with a slightly higher co-pay; no-cost tier 1 drugs by mail order; and many other benefits. Also, the coverage has improved each year, probably caused by the competition from other private insurers who want to capture some of this business. I see it as a win-win--and I wonder if Warren's rigid clinging to M4A will be the death-knell of her candidacy. Sure hope not!!
2
I appreciate the standard to which democrats hold themselves and their dialogue. They may just miss the forest for the trees.
Here are some Trump quotations throughout his run and presidency:
"Healthcare will be the easiest to solve."
"Nobody knew that healthcare was so complicated."
"Bing, bong, bing, bing, bong. I was imitating puppets."
"Megyn Kelly had blood coming out of her eyes. Or blood coming out of her wherever."
Democrats are eating their own over healthcare semantics when the opposition bombastically advertises nothing coherent, let alone valuable.
Trump 2020 will be an exercise in natural selection. Yes, the environment takes a blow. Yes, global geopolitics take a blow. Yes, minority groups take a blow. But hopefully the worst blow lands on all those who elect to pet the orange frog. One final tantrum. One final gasp for air. One final Hail Mary pass to invoke the security of an obsolete past as the ground shifts beneath them.
What I fail to understand is that if you are in business you use the best business practices you can find. Why don't we simply find the country who has the best practices and use that model?
I'm really tired of us Americans paying to subsidize the medical costs of every other country because we allow them to cut better price deals than we get, and we as Americans make up the price difference so the medical companies can make a profit.
It aint brain surgery. Justs take courage for the politicians to stop suckling at the lobbying nipple.
1
Dr. Krugman hammers Sen. Warren on how to cover costs. He doesn't seem interested in how Sen. Sanders or anyone else will cover costs. Or even whether they have a plan. Or even whether they are committed to affordable Universal Health Care, which is the object of all the arm-waving.
C'mon, Paul, this is letting the good be the enemy of the perfect. Or perhaps the enema of the perfect.
SMH
Basically agree with USNA73 and Krugman on this. Even Richard Nixon's health care plan back in the early 1970s would most likely have evolved into universal health coverage by now.
The main issue I see is the significant overlap between people who have private insurance and people who vote. Going for M4A is likely to spook enough people who have private insurance to not vote for Warren and that would be an unnecessary tragedy. Why not go for a public option and grow a universal healthcare system because it has so many more benefits than a private one.
2
I cannot see any scenario where current Medicare beneficiaries are not given substantial economic incentives to support the new arrangement. Those are the only ones who have to be given enough if monopsonistic healthcare price control system such as Medicare-for-all has any chance of being enacted.
The first reaction from many current Medicare beneficiaries to the idea of Medicare-for-all, might be related to the issue of others getting immediately what they have paid into for many years while they did not get any benefits. At minimum, current Medicare beneficiaries would chafe at the idea of having to pay new taxes to pay for Medicare-for-all, and not getting anything for those taxes, other than the Medicare already have now.
The proposed status of current Medicare beneficiaries will be the key factor if a Medicare-for-all type system has a chance of being enacted. To put it bluntly, current Medicare beneficiaries will have to be bought-off. One fair way to garner the support of current Medicare beneficiaries would be to grant them a special deduction that could be applied to their adjusted gross income for Federal income tax purposes. The special deduction could be the total amount paid for Medicare tax by both themselves in all years that they were not receiving Medicare benefits. This would be above $100,000 for a typical couple. It might be capped at some amount so as not to benefit very high earners who may have paid more.,,
https://seekingalpha.com/article/4111577
1
On this issue only congress can act to make it better or worse. Many if not most congressman get elected by corporation support, and much of this support comes from medical companies. Until something is done about this, Americans will continue to pay twice what other countries are paying for health coverage
I wrote Team Warren months ago with similar concerns, albeit less eloquently expressed than those of Dr. Krugman. It's likely that many other grass roots Democratic voters communicated similar concerns to Team Warren because a plan for health care insurance was conspicuously absent from their website and mailings despite the candidate's mantra “I’ve got a plan for that”. Team Warren’s response was that I should look at their website which I told them I already had and which contained nothing approaching a plan for health care. Three months later I watched Warren be evasive when she was asked if middle-class taxes would increase under her plan. She was either curiously unprepared or unwilling to answer in a straight-forward way. Now she says that she’ll reveal her plan soon. Bated breath indeed.
That is why Obamacare is brilliant. It basically delivered fresh clients to insurance companies, while getting people, especially the young, to do more preventative care, and protecting so many people from sickness. The only mistake was to mandate that every American should buy health insurance. Although, completely sensible and something most people should and want to do, to make an American do something, goes against the individualistic spirit of some Americans. I'm not even sure, it's constitutional. Better to have slipped the cost of insurance premiums into some kind of a low key tax. I agree that if we were starting from scratch, the single payer government system would be ideal, but with the clout and lobby of insurance companies, it will be impossible to phase them out, especially that they employ tons of workers. We should have a public safety net for all, and those who want can stay or buy additional private coverage for faster care, etc. Many people will abandon their private plans for the public option, I'm sure, but let THEM make that choice.
What’s missing in the national debate about Medical-for-all is the question of TIME. In 2016, Bernie Sanders proposed a four-year plan. Now, he and Warren are calling for covering all Americans—a third of a billion people—in ten years.
Such overpromising is a mistake; it will drive away the swing voters without whom the Democrat cannot win the Electoral College.
So, yes, Elizabeth Warren, level with us how your plan will be paid for— but also tell us HOW LONG it would take.
For a realistic perspective on the question of time, I recommend Charles Gaba’s now-famous 2016 blog post: http://acasignups.net/node/3085
With such proposals, the focus is always on the rate payers, but that's not the only facet that needs to be examined. Few in contention for a better system pay much attention to the massive health care industry in the US. All of the people who work in health care but especially those incurred serious debt to be physicians, nurse practitioners, physicians assistants and nurses, depend for an adequate living on the way the system is today.
My personal opinion of the system is that it's hopelessly cruel, with a vast number of Americans living just one medical mishap away from destitution. But what about the providers? Will Medicare for all or a single payer system provide adequately for them also?
If not, we can't expect much to change.
1
Medicare for all is not socialized medicine, because all the providers will remain private entities, who will game the system, just like they do now. In addition, what is paid by employers will fall on the backs of the taxpayers, and there is no way to avoid increasing costs for most people, especially since coverage will be expanded without expanding supply, and "the poor" will be heavily subsidized by the middle class. Relieving business from paying the costs is not going to be fully passed on to either employees or customers, but rather to shareholders. The main source of high medical care costs is high prices charged by providers. Medicare controls that by paying drastically less than private insurers. Will Warren make it illegal for providers to opt out of "Medicare for all"? Scotus will knock that down in short order; it's a free country. Providers will not stand for having their incomes cut in half. Meanwhile the elimination of insurance companies will be made up for by medical inflation (from providers) within just a few years, if providers' prices are not put under price control. It will be chaos.
Hey Liz, I hope you’re listening.
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I hope not!
I heard a uaw union exec on nrp talking the pending gm contract. She said gm messing in any way with healthcare was a dealbreaker. If our dem nominee is for eliminating Private healthcare we Dems will lose. Right now warts and all I’m for Joe. It’s that simple. Kaiser health polling: 37% for singlepayer, 73% for an option. Dems, get Sm͏a͏rt. Ginsberg can’t live forever.
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@Joe doaks :"If our dem nominee is for eliminating Private healthcare we Dems will lose."
If you look at the unionized autoworker (UAW) there is no way any plan that Warren or Sanders comes up will provide the type of policy the UAW worker gets to all the people in the US. Somebody is getting less.
@yulia (who correctly points out that if the Private option is allowed the corporations will fight tooth and nail to corrupt Medicare for All)
Exactly! And that is why the center right Democrats (Biden, Buttigieg and Klobouchar) backed by "theorists" like Krugman are fighting for the Medicare for whomever wants it. They know once it is an option, private companies will get what they want through what is known as "bribes." PACs, lobbyists, disinformation commercials, denials (think J&J full page ads in the Times claiming there is no asbestos in the talcum powder until it was proven otherwise, those ads are still not retracted by the Times who published them for big cash).
This comment won't be published with almost certitude but it is a free country, I can waste my time.
1
You - an economist- cite three key points in your introduction to M4A. Only one of those arguments falls within the realm of economics- and its a strong endorsement of M4A. The other two fall within the realm of politics. They ring of talking points proffered by Joe Biden or David Axelrod. Stick to your knitting Professor Krugman.
1
Stick to yours, because what Krugman actually said was that M4A is far from the only way to get to universal coverage, that Sanders’ plan to offer everything is economically ridiculous, and that a phased-in, restricted M4A covering the real necessities was probably both affordable and achievable.
As a side note, as we debate this issue, perhaps we should be mindful of the deep complexities of universal health insurance and how Medicare claims are actually administered today. “Since Medicare’s inception in 1966, private health care insurers have processed medical claims for Medicare beneficiaries. Originally these entities were known as Part A Fiscal Intermediaries (FI) and Part B carriers. In 2003 the Centers for Medicare & Medicaid Services (CMS) was directed via Section 911 of the Medicare Prescription Drug Improvement, and Modernization Act (MMA) of 2003 to replace the Part A FIs and Part B carriers with A/B Medicare Administrative Contractors (MACs) in accordance with the Federal Acquisition Regulation (FAR).”
https://www.cms.gov/medicare/medicare-contracting/medicare-administrative-contractors/medicareadministrativecontractors.html
I am 70 years old and I wouldn't trade my Medicare for any of the private plans that I have been "under" in my life including the one that drove me to medical bankruptcy.
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Warren and Sanders favor eliminating private insurance because to make it financially viable, everyone needs to be in the pool. If only those who choose to be in the system sign up, it will be a financial implosion.
In Britain everyone pays into the system, but if you have the money you can go to a "Harley Street" doctor. We don't have to re-invent the wheel. Over 60 civilized countries have some form of single payer delivering higher quality healthcare to more people at lower cost than the U.S.
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Bingo! That's currently the weakest plank in her platform. I hope and pray that she uses all her considerable smarts to figure out a better plan for healthcare.
1
Agree - with Mr. Krugman and many commenters: Can we help make this the conversation?:
"Maybe something like an extended transition period, with greatly enhanced Obamacare (which might actually be politically doable) in the interim?"
Luv you Professor. There is only one route to universal coverage and you state it at the end of your article. Either we will get enhanced Obamacare as a slow bridge to single payer or the GOP wins and the uninsured continue not to see the doctor. Personally, the idea of universal in the next ten years, to me, is too big a leap. As we sit here dreaming, Trump and the conservatives are throwing people off government-paid medical insurance every single day. We need to quit with the pie in the sky. The uninsured are growing and the left's answer is to go from negative to universal? It's unrealistic. A more realistic short-term goal would be to lower the Medicare age to 60.
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Of course she can. She already said she is with Bernie on Medicare for all. She will have a similar plan and needs the time to be careful to have all the details. What we do not need is Mayor Pete attacking her because he is doing the bidding of his insurance company donors. And he is out and out lying about Bernie's Medicare for all costing trillions of dollars and creating a big hole when it actually saves us 2 trillion dollars and provides us with better health care than we now have. He is trying to make Medicare oh so scary because he loves the bribes. Even the Koch brothers' team came up with Medicare for all saves us money. Yes Bernie will raise taxes slightly on the middle class who will save more money than they pay in taxes because there will be no co payments, no deductibles, dental and vision and hearing will be covered. The corporations and those hanging on to the status quo ( corruption ) are now pushing Mayor Pete because Biden is going down and Kamala has not worked ou. And they love hid right wing talking points. The local news organizations in South Bend have finally looked into how Pete got rid of the first black police chief, then had to demote him instead because of the uproar, because some of his big local donors wanted him out. And most of the black policemen on the force there were driven out. Go to TYT network and read up on Jonathan Larsen's report of the racism Mayor Pete tried to cover up. Mayor Pete is corrupt.
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@cheerful dramatist
Most of your comments here are patently absurd and thus need no response, but one issue deserves comment.
It may be true that the elimination of copayments and deductibles will balance out or exceed the cost of additional taxes, but what about the millions of Americans who have no need hear after year to use their insurance? For them, the increase in taxes is all they will book.
The reality is that Medicare for all will be a savings for some, but by no means all.
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Among the ways Trump can win: “leftists,” who have zero idea about the simplest aspects of health insurances, and throw everything they can lift at centrist candidates because they’re embarassed about it.
@Robert And your expertise on those vulture insurance companies? Good God you cannot possibly think they are nothing but scams. And leftists like me think centrists candidates are horrible, horrible shills for the horrible insurance companies and do not give a darn about the people they scam. Like Mayor Pete who takes huge donations from the so called healthcare industry and then bashes Medicare for all because he likes the bribes. What a rotten person he is , trying to sell out the voters so he can have more campaign money.
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Why the insistence an terming medicare for all as a single payer not private insurance when that is not what it is today? Medicare has deductibles, it has tiers (Part A, B and D). Medicare has a supplemental private insurance options available. It's pretty complex as it stands.
What it does do is cover everyone over 65 and is paid for by taxes. Would I be willing to buy into Medicare in lieu of my employer insurance in the form of taxes? You bet. It would be cheaper. It would be less complex.
Cheaper - today for the "best" insurance I pay over $400 a month in premiums. I would need to pay an additional $7000 out of pocket before the insurance would pick up 100%. The only thing covered is preventative - basically a yearly physical and blood work, that's it. Every other doctor visit run $150 or more. If strep throat runs through your family you'd be looking at more then $1500. And I haven't addressed consistency on insurance forms and approvals as a savings
Less Complex: I won't have to deal with "networks" My last colonoscopy - the facility was in network, the doctor was in network the anesthesiologist was not. Really? I need to get a list of all people I would possibly be seeing and verify their network? Drugs - the same issue on their formulary, and cost seems to be irrelevant as to what is on any give list.
1
Medicaare recipients also pay premiums, deductibles, co-pays and co-insurances.
@Robert
Medicare costs:
I you paid medicare taxes for 12 year or more this is no premium for Part A
Part B - 135.50 per year, premium if income is less than 85K. Deductible and coinsurance 185 per year
Part C - is a private plan that has a premium that is under the medicare umbrella
Medicare maxes out at 80% that is why there are supplemental plans that are affordable. Therefore private insurance is not going away.
https://www.medicare.gov/your-medicare-costs/medicare-costs-at-a-glance
Warren has defined herself as a capitalist. She should help people understand that a profit driven free market is not sufficient to address health care, but that it should not be entirely dismissed either. There is a place for M4A, but not necessarily at the expense of private insurance. Most Americans like the options capitalism gives them, regardless of its flaws.
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Medicare for all would work financially. Multiple studies prove it. It would also solve many of the currently intractable issues in U.S. Healthcare.
Total expenditures, in the long run, would not increase despite adding 25-30 million persons to the insurance rolls. Single payor by definition creates administrative simplicity which will save over $250 Billion per year. Chronic disease programs would be financially viable. Presently, no rational employer is going to fund a program that requires up front investment to get a 5-7 year or longer payoff when the average employee tenure is 4.6 years and declining. The "surprise billing" issue disappears. Health record interoperability issues can be solved. Social determinants of health can be funded. The "job-lock" that occurs today over fear of going without insurance disappears. The pricing excesses that occur due to the market inefficiency and opacity of the U.S. Healthcare system can be negotiated out. Evidence-based care would become standard. Consumer choice and market competition when selecting providers would be based solely on quality and service. And so on.
It should be a no-brainer. It also will never happen because the industry has so much lobbying power. The industry has run focus groups. They know that phrases like "socialized medicine" and "government health care" work to squelch any real change. And the vampire squid will continue to feed on middle class savings and economic competitiveness.
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I worry that she can be baited. She got the DNA test because of Trump. Now, she is attempting to flesh out the Medicare plan because of rival candidates. If she gets the nomination, what else will Trump convince her to do, to her detriment?
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I thought I posted this earlier, but I don’t see where it has appeared. So, at the risk of repeating myself, the subject of Medicare and health insurance administration is deeply complicated. Many comments posted here seem to envision simplistic solutions which involve the elimination of private insurers. That is an interesting thought, but let’s keep in mind that the claims of Medicare beneficiaries are currently and have for years been administered by private insurers.
https://www.cms.gov/Medicare/Medicare-Contracting/Medicare-Administrative-Contractors/MedicareAdministrativeContractors.html
1
An unspoken reason Medicare for all is unpopular for many of the voters needed to win states like Wisconsin, Michigan, and Pennsylvania is that many white working class voters see M4A as a scheme to transfer the tax revenue paid by hardworking white folks to lazy and undeserving minorities. That this is delusional and racist does not change the fact that a plan to greatly expand Medicare will cost Warren, and many Democrats up and down the ballot, votes in 2020.
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A rough estimate is that for a family of 4 paying 28000$ to insurance companies per year would instead pay 15000$ taxes in lieu if the 28000. Thus, taxes go up but the family saves 13000$ per year. The rightwingnuts will tout this as a tax increase, and probably win the debate since they have 100s of millions waiting to deploy on false ads plus plenty of help from the Russians, Saudis and Israelis.
@Hair Bear Your hypothesis depends on the employer(s) returning that $28,000 paid in health insurance (if the parents are in an employer plan) to the workers. Any single-payer plan has to have assurances that the savings in not paying for private insurance gets returned to workers.
Of course President Obama promised "if you like your plan you can keep your plan" before canceling insurance for more than 10 million Americans like me! Too bad for me, but at least he did provide free healthcare for millions of Latin American citizens who managed to sneak into the US.
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I find it difficult to give credence to the party of African-American and Hispanic unemployment. They DEMAND points for paying lip service to their love of "people of color" and "the other" while sentencing 40% of us to their ghettos. In another life, more people will understand the Paul Krugmans and Elizabeth Warrens of this world as the TRUE racists by virtue of the effects of their policy recommendations on the population they insist they're helping so greatly, though probably this is both BEYOND most of those reading this, as well as NOT particularly in your true interests, anyway.
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"Can Warren Escape the Medicare Trap?"
The better question, Paul, is can our country escape the Medicare trap? You could also ask this question of any other federal entitlement program you care to name. As to Medicare, Paul, you could start with this:
https://reason.com/2011/12/13/medicare-whac-a-mole/
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Let's get real. As Democrats argue about health for all the Republicans are waiting for their chance to eliminate Obamacare and replace it with.... nothing.
I’m surprised I haven’t heard anyone suggesting that Mexico will pay for it.
Good advice!
We have military for all and we are happy to pay handsomely for it - how about medicare for all to help with those who are in the military, out of the military, or are affected by the result of the military?
I think too many people, including the media and some candidates, are focusing too much on the question of costs.
As important as that question is, I think the most crucial political question concerns how Warren responds to the fears and concerns, rational or irrational, that many people have about losing their private insurance. It would be a huge political mistake to ignore this. There must be ways to fold private insurance (for those who want it) into a modified, phased-in MFA for the short-term. I for one am extremely disappointed in Warren's lack of sensitivity to this.
I am also disappointed in MFA advocates' insistence on a particular bill or approach to universal health care. There are a variety of models and approaches (e.g., Germany, Switzerland, Taiwan, UK) from which to select and choose so -- through negotiation and joint consultation among stakeholders -- we can draw up a hybrid model that fits our culture, society, and economy. It might take some trial and error, but I don't think that anybody really knows what will work best here. As it stands, I think the Sanders MFA bill is too sweeping and too abrupt a transition for many Americans to swallow. Insisting on this single, rigid approach risks disaster both politically and in our health care system (which is already a mess).
1
Do Mayor Pete or Amy Klobuchar have a specific plan with all the details worked out. If so let’s analyze it. My sense is they have not given it much thought, other than as an opportunity to undermine Warren and Sanders, who both focus on the outrageous expense of care and have meaningful plans to reduce that COST.
I’m now on original Medicare, I pay less than $200 a month in premiums, have an annual deductible of less than $200. and have NO co-pays. I have my choice of physicians, hospitals, etc. Flu shots and annual physicals are included. I do pay 20% of MEDICARE negotiated rates for physicians and facilities, as an example I recently had hernia surgery, my portion of the surgery center fee was $297.41, the surgeon fee was $108.31, anesthesia fee $29.00. And I had the best care throughout the process. It’s like stepping back decades in time when a person could afford health care!
Before Medicare eligibility I had $5000-8000 deductibles, over $1000 a month premiums, co-pays for every visit and a myriad of hoops to jump through. I don’t believe Pete or Amy are being honest about choice, who would choose to pay more for less coverage and more uncertainty?
1
@Gus Your premiums are what they are because you've paid into it for 40 years.
Phase in Medicare ... add in those who turn 64.5 years old, then 64, then 63.5, then 63, etc. Hire more federal Medicare employees to provide service for the increased number of Medicare patients. Private health care companies will adjust (downsize) over time and hopefully become more competitive.
Yes, it will take a generation to achieve what should have been implemented decades ago ... but it won't shock the economy if adopted gradually.
3
The only thing that can allow Trump to win in 2020 are some of these far left proposals. Replacing people's private insurance with a single payer system, and decriminalization of illegal crossings at the border are the only path to victory for Trump. He will beat Warren's brains out on those two issues. I do not understand why she cannot see that.
3
The cost of America's healthcare system is unsustainable. Costs have been and are raising substantially in excess of both inflation and wage growth. The for-profit model is just not working. There is no "free market" for healthcare.
Anyone who has health problems understands just how inefficient the system is. Doctors are still carrying beepers from the last century. About 20% of all medical costs are administrative. that is, we are paying for the argument between providers and insurers. Not to mention the substantial profit payout.
Only government intervention can change the cost curve. Whether it is single payer or some other system where the government essentially determines prices matters little.
2
Has anyone reading this spent time at the VA, Indian Reservation Hospitals, or even a Medicare run nursing home? If you have, you know it's not just about cost, it's about quality and availability of care. The US track record for government health care in a closed payment system is poor. The VA had over 600K backlogged disability claims in 2015: delays of over 120 days. That number is now 73K, but there are disputes over the level of reporting accuracy. As a percentage of the Disabled Vet population, that's 2%. 2% of the total US population would be 6.4M people. That's a lot of people without access to health care for at least 4 months. This is but one illustration of how the US government does not provide timely high quality health care. Using the current Medicare system, which is subsidized by the private pay sector, is not an accurate example of it's efficacy. The embedded costs of our system, even if vastly overpriced, will make any Medicare For All system far, far more expensive than anyone is now calculating. Obamacare faltered badly at inception and prices doubled. Simply mandating costs won't provide better care at a lower price. If the US bought out private health care, we could have a Medicare for All system with total and accurate accountability, but that would cost trillions we don't have. Adding a public option for those without coverage makes total moral and economic sense. Replacing all other existing coverage with an untried model does not.
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"people who have good private coverage"
The irony is that People don't have any idea of how good is their coverage until they face a serious health issue. Then it is too late for them.
Most people (employees) don't have any role in choosing the kind of health insurance they get. Their employers decide who get it and how much coverage, and how much they have to pay. To say that these people are afraid of Medicare for All is to mislead them. If the Medicare for All Plan clearly and succinctly lays down how much coverage and how much it costs then convincing them is not all that difficult.
It is natural, human, and political to worry about the financial details of paying for health care, and for how any changes would be implemented.
But it is more important to consider:
a) how human beings now and in the future are tended to, cared for, treated, and appreciated when it comes to their physical and mental well-being -- because that well-being is ultimately a soulful part of existing on the planet,
b) and right now, America's health care system is a bureaucratic bad dream, with a small number profiting from the illnesses, anxieties, and inevitable human frailties that most all of us experience at some point.
c) Whatever change comes next will be difficult and painful -- but it must come, because the one we have will only become more expensive, complex, and unfair. People in America deserve to be treated like people -- not numbers, cases, or events.
Warren needs to explain a lot more. But we the people need to help more, not just demand more for ourselves. If we can't change, we can't expect "the system" to change.
Let's support someone who gets us closer to a humane, practical, and reasonable system -- slow, difficult, and sloppy as that will be.
2
The film "Fixit:Health Care at the Tipping Point", estimated that our private health insurance industry wastes over $700 Billion a year on administrative costs, not one penny of which is spent on actual health care. Under any single payer plan, that waste would be eliminated and returned to the consumers of health care. That's a big chunk of of how we can pay for it.
2
I have been asking some of these questions for months now, and I hardly ever see anyone else asking them, much less answering them. To put it bluntly, what is the plan for getting Medicare for all through Congress? It seems to me that both Warren and Sanders are being disingenuous about this. As much as I like Warren, this is a bridge too far for me. I would also like to know how they are going to deal with the economic disruption that would occur. So far, the only sensible solutions have come from Buttigieg and Klobuchar. Allow the option for people who want Medicare or expand the ACA with a public option. It’s going to be an interesting year.
2
Must politicians always try to implement good ideas all at once?
In 1993, Bill Clinton proposed HillaryCare to Congress. It failed to pass. (When you try to boil a live frog all at once, it hops out of the pot.)
If, instead, Bill and Hillary had proposed that, every year, the age of eligibility for Medicare would be reduced by one year, and that proposal— modest and incremental—had passed; then everyone who, at the time, was thirteen years old or older would be eligible for Medicare today.
2
Most true reform has come from blowing up what is critically screwed up. That goes for wars and the Great Depression too. But, people can't aspire to this level of destruction just to get a chance to start over. Why the heck don't the Democrats realize this and just take the low hanging fruit, Simply add a public option to the ACA. People will catch on, albeit slowly, on the path to single payer. Maybe sneak in a 55 and over age threshold for existing Medicare. You can also perform true magic by forcing Big Pharma to negotiate drug prices with Medicare. How about someone present the story incrementally. Then maybe we'll win and control the levers that can assure we improve people's lives.
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@USNA73 I think she needs a national platform like a debate to detail what this means. Putting out detail this early in the race can easily be "spun" by her opponents. She is more pragmatic and smart to know what will work and what will not work. This is an opening position.
4
@USNA73 You can thank EX-senator Joe Lieberman and his big healthcare employed wife for there not being a public option. We needed his vote for the ACA but he made that conditional on his yes vote.
13
@USNA73 From one fellow Navy vet to another, thank you. Your comment was the most sensible one I've read in quite some time.
6
Have we exhausted the discussion about employer-sponsored health care?
Why should an employer have any say at all about the nature and limits of health care for an employee's family?
Practically speaking, whatever the next president proposes, she or he will have to work with Congress to propose a bill the majority will support.
Let's not nail down the details until we know who is running congress.
Candidates set a destination, knowing it may not be reached, and voters should be assured that Warren or Sander's desires are not caste in stone. A process will follow, and when you have to compromise with Republicans you know phased-in M4A is the closest we'll come to it for a long while.
I really hope voters don't one-issue this 2020 election! Take a look at the full picture and ask yourself: will we be kind to one another, or cruel?
This article could apply to every aspect of the liberal platform.
Yes, everyone wants more free stuff. No, we don’t want to pay for it. Then, they throw rich people under the bus and hope no one can actually do math.
1
@Johnny So you bandied about that Fox Buzzword "Free Stuff". Do you mean "Free Stuff" such as tax breaks for corporations and lower rates on capital gains? You know, the kind of "Free Stuff" currently given to the one per cent? Just curious.
2
EVERY solution to universal health coverage gores someone's ox. No plan, including doing nothing, spares everyone.
Draw a triangle and label the 3 vertices as FAST (or comprehensive), GOOD and CHEAP. Underneath add the caption: CHOOSE ANY TWO.
FAST + GOOD = not CHEAP
GOOD + CHEAP = not FAST
FAST + CHEAP = not GOOD
This is true for any problem for which a solution is sought and will ever be so.
For health care, we need to find the most comprehensive plan possible having a bearable cost. There is an historical approach which could work nationally if not for the iron rice bowls against which it would be pitted.
In 1969, Oregon began a process of ranking health conditions from most effective to least effective and allocated its Medicaid funding in rank order to get the most bang for the buck. Maternal-child care and pneumonia treatment for example outranked elective plastic surgery.
Comparative effectiveness research and deployment could squelch the otherwise inexorable advance of high cost treatments of dubious advantage or, in the case of pharmaceuticals, might significantly drop their costs.
Although there is a steady drop over time, 13% of total costs for traditional Medicare were for beneficiaries in the last year of life. ( https://www.kff.org/report-section/medicare-spending-at-the-end-of-life-findings/ ). More discussion of patient's preferences throughout life can reduce these costs further.
There is no magic bullet for heath care and SEN Warren knows it.
5
If Elizabeth Warren doesn't drop Medicare for All and switch to Medicare for All Who Want It then she's unelectable. UNELECTABLE!!!!
3
No she can’t escape the prison cell she created, but she will sure as heck try and lie and obfuscate her way out of it with the liberal media nodding in agreement with her mis truths. Thankfully she has 12 or so opponents who keep bringing up reality and he inability to answer a yes/no question with a simple declaration of yes or no - instead we get a lawyerly answer.
America, welcome to the pain I face as her constituent.
1
I think it is foolish to constantly try and finesse things. Soon even Mitt Romney will be accused of wanting open borders, socialized medicine, socialism in general and free, safe, legal abortion on demand.
1
Instead of touting Medicare for all as the primary tool, I would suggest that those currently running for office consider adopt one or more of the following proposal in current tax treatment of health insurance premium deductions by individuals:
(1) allow full deduction of medical insurance premiums for all individuals above the line ( i.e as a deduction on schedule 1 that self employed and s-corp owner can do so) even if some one is an employee or a retiree.
(2) employees who pay for their own health insurance can get tax credit for payroll tax reductions currently enjoyed by employees of companies that provide health insurance coverage.
(3) provide and strengthen health insurance offering in current health insurance market place to allow for offerings to families that do not qualify for premium tax credit, including Cadillac plans that some families may want to buy on their own because their family members have specific health care needs.
These simple changes would level the paying field for employees and non employees and retirees, and physicians insurance companies as well as individual families would all be much more interested in participating in this modified health care market place.
3
This is an excellent column. I'm one of those people Dr. Krugman is addressing. I get my insurance via my employer. I have a PPO which costs $7200 a year. I pay $2400 out of pocket for this plan. I would like to explore a public option to see if the level of care is the same and the costs are less, but I don't want all private insurance eliminated. Senator Warren is an incredibly intelligent person, but I fear that she's let political expediency overrule pragmatism.
3
We Americans are funny. About half of us voted for a candidate who promised us "beautiful healthcare," even "better and cheaper" than Obamacare. Reporters never hounded him to answer, "How are you going to pay for it?" or "Will you raise middle-class taxes?" or even, "Will everyone be covered?" Trump won on a "Trust me" healthcare plan. A pie-in-the-sky, die-quickly, go-bankrupt plan. But here we have Dr. Krugman taunting "the candidate of plans" to produce "a really good one" or go down in flames. And we have voters, still, who will trust Donald Trump with their health, their livelihoods and their children's lives before they trust "the government" that gave our retirees Medicare, which has immeasurably improved and prolonged our parents' and grandparents' and our own lives. I am almost ready to give up on America when it comes to healthcare, including the news media and pundits who frame the healthcare debate. I guess the richest, smartest, most Christian nation in the world just can't do any better. It's every man, woman and child for themselves here. I should "get over it."
4
These numbers could make or break Warren and Bernie for that matter. Universal health care in this country may never take off. People have no idea what it is, how it works, nor do they want to find out. Even though they have expensive coverage through work they are not going to let it go. Many folks stay in hateful jobs, only for the health coverage.
I came from Canada and survived the change over, way back. There was not the hew and cry that is seen here but we Canadians are rather passive. It worked and it works. I have not met an unhappy Canadian about their health care and, if they want to throw away good money, they can always pay. Some do.
1
If Warren wants to be the nominee, she absolutely must "escape the Medicare [for All] trap." If she wants to avoid being labeled a "socialist" rather than a "capitalist" as she's said, she must allow the free market to work and consumers to have a choice. If she wants to keep health care as a winning issue for Democrats as it was in 2018, she must avoid imposing Medicare on those already happy with their current health insurance plan. If she wants to avoid a massive attack (remember Harry and Louise) by the health insurance industry and even some hospital associations, she must not propose eliminating private insurance. I hope she can pull it off because at this point she's clearly the strongest candidate.
3
So much of this centers on the words that are used. She can avoid traps by saying that she is open to Universal coverage that would be similar to Germany’s (and other countries) that is in effect Single Payer but it’s done through many insurance companies. However, they are highly regulated and must be non-profit. So she can say the words “ You can keep your insurance “ and not get nauseous. The Sanders crowd will just have to “get over it.”
1
If we could snap our fingers and make single-payer happen, we would. But we can't. So dramatically altering our health care provider infrastructure will come at a cost and transitional complications. Think of all of the people working for private insurers who will be displaced by a single-payer shift. There will be room for many of them to work for the state, but not for all of them because we will not have the redundancies that exist in our current system. So what do we do with them? None of the candidates is talking about this transition. They better come up with a plan for that. https://madsociologistblog.com/2019/08/24/the-infinity-snap-fallacy-of-movement-politics/
This is an infuriating issue.
Senator Warren, like every other viable Democrat, is committed to expanding access and reducing costs on healthcare. Trump, sociopathic toddler that he is, wants to impose financial ruin, misery and early death on millions, including millions of his supporters, because the current law is nicknamed "Obamacare." But the press and public will fixate on the minutiae of Warren's good intentions while ignoring the enormous human damage Trump would cause.
To be fair, this is one among the many problems a coalition faces when doing battle with a cult.
3
The left has consistently lied and misled the public when it comes to healthcare. "If you like your doctor you can keep your doctor. If you like your insurance plan you can keep it. Period". All deliberate misdirection. ALL single payer systems require HUGE tax loads on the middle and lower middle class making modest salaries. It cannot be paid for by taxing the wealthy and corporations. And health care shortages always develop for rationing is part of the plan of single payer, again held back from the public when it is sold to them. Do you really think the UAW members who get private health care at very little cost are just going to give it up so they can get VA style health care? Get real.
2
What is so hard to swallow about Medicare for all who want it? Mayor Pete is the man. Read his book. It is an A-Z formula for a youngster with bright parents who over acheived and then acheived.
ou
I am a 2nd generation Mexican American retired opera singer. I speak 5 languages. Mayor Pete, you're swell. Plus you play rock guitar and classical piano. BRAVO DUDE.
Ps My long time gay friend at work thinks Pete isn't "GAY enough". I give up! America? Where are we?
1
Hugo's Benevolent Dictator Proposal to "Save America and its Health Care"......
1. Abolish National Health Care....and the Insurance System.
2. INCREASE Federal Funding of Medical Education for American Citizens......we need MORE doctors. Increased supply of doctors alone will alleviate prices.
3. INCREASE Federal Funding of Cancer Clinics.....remove this particular medical issue from the Insurance pool.
4. Change the Patent System to break the Monopoly on drug manufacturing.
5. Remove the bogus pill pusher industry from America.
Trump wants to eliminate Biden and run against Warren. That should tell you all you need to know.
The column brings up the Urban Institute study, arguing Med4All will require taxes of $34 Trillion over 10 years (Interesting how the amount rises, Biden originally accused $30 Trillion). Ms Woodruff on PBS last night confronted Bernie with the figure, he swatted it out of the park by saying, again, this current system will bill us all $ FIFTY TRILLION .
Begs this question: how is what we got being paid for now (costing, at napkin sketch 18% of a $20 Trillion GDP, $3.6 Trillion)? By a whole lot of taxes. Directly though Medicare for geezers, Medicaid for poor, and subsidies for ACA. Then out of pocket for those who have to pay for their own (who should really love Med4All) leaving that Employer provided group... which, while some Madmen say shareholders pay, is actually paid for by consumers...US!
A hidden, privatized, tax if you will.
That Rube Goldberg system, with no way to reign in cost inflation, is not sustainable. $50 Trillion by 2029.
Public Option? SC finds requirement for private corps to cover existing conditions unconstitutional, in that such folk can go to public option now. All the sickest swamp ACA & taxes rise considerably (how many tax $$ for subsidies now?)
And Gov as sole payer is only way to control costs, particularly for meds.
Ms Warren needs to can the Madmen who convinced her to avoid the T word at all costs.
Finally, Med4All allows Medicaid folk to leave a 2nd class status, move up to equality. A Red state plus, if Dems got the guts to use it
1
@M. J. Shepley
Bernie (and by default Warren's) plan didn't work even in Vermont and was scrapped.
@Maggie
works in countries all over. But only country wide works.
What B7W have got to call out, right in the middle of the next debate, is anyone who says "you will lose your coverage". That is a Corp Madmen bumpersticker that is a lie. No one will LOSE anything, just switch--- to something with more that is cheaper.
Any candidate pumping out that corporate narrative (lie) is disqualified for the Dem nod, period
@M. J. Shepley
Only works in Taiwan and Canada, the only 2 nations with universal health systems.
All other nations have a public/private buffet health care system, as does the U.S.
hopefully her answer comes in the form of a graphic representation.
1
In the last congressional elections the Democrats were able to flip 40 seats. Of those only 2 were progressives. Please focus on the electorate. Here in the Midwest I don't believe there is enough support for anybody perceived as a socialist. Lets get rid of Trump!
What’s so great about private health insurance? The insurance companies’ principal goal is not to provide health care. It is just the opposite: to provide as little health care as possible in order to maximize profits.
They start by rationing health care to the healthiest, weeding out anyone who might actually be sick or become sick. They do their best to reduce “insurance losses” by refusing claims, contesting expenses, imposing lifetime limits on care, limiting the payout per illness and by invoking the fine print to cancel costly clients. They also create enormous administrative costs for those who battle the insurance bureaucrats.
If there were no government regulation, you can predict that some of those companies would become nothing more than premium-collecting businesses, their hands out when you didn’t need help but quick to cancel coverage if you became seriously ill.
It’s the government that does all the health care heavy lifting — Medicare for old people, Medicaid for poor people, and the VA for veterans. According to the estimates of some medical experts, those three agencies remove as much 85 percent of the risk from the health insurance pool, leaving the healthiest segment to private companies.
Polls show that these three programs are enormously popular, partly because the government won’t cancel your coverage when you get sick or lose your job.
What’s so great about private health insurance?
2
Dr. Krugman points out the different European countries (and Canada, btw) accomplish universal coverage in different ways. What he neglects to mention is that these countries make preventive care their highest priority, whereas in the US we provide care reactively, which is much more expensive and results in a lot more suffering.
As a duel citizen, I chose to move back to Canada, primarily for Health Care reasons. Prior to Obama care my BCBS policy refused my Total hip replacement:(pre-existing). I had to quit working and wait 8 months to qualify for Medicaid, to pay $57,000 for the procedure. I got a medical visa to India to get it done at a $11,000 price tag including flights and one week stay in a 5 star hotel, before I flew back half way around the world. Cdn option was $18,000. After 3 months back in Canada your provincial health status is renewed. I have had many surgical procedures here in Canada, with no out of pocket expense. It is part of the federal and provincial tax base. It is not free in Canada, you have to plan well in advance on how to game the system, getting the required tests, from your Family Physician, and waiting ~7 months for elected procedures. If it is an emergency your at the front of the Q. People here do not go bankrupt when they a serious illness. They get the same care as everyone, although extended stays may find your place in a ward, and not a private room.
2
I am in favor of single payer but I also believe it must be incrementally done. We (or Warren in this case) need to identify the single most important problem to be fixed and work on that alone. To me, that is the high cost of healthcare in the US relative to other countries.
So my suggestion is to start with the $3.4 trillion we now spend and use that as the budget for the new system. If it is going to lower the cost then this should be an easy goal to achieve and it won't cost Americans any more than we are paying now, but it will change how we pay.
Once we get costs under control, then add more features and benefits to the system such as zero deductible and zero co-pay and prescriptions or whatever. But in the interest of fiscal responsibility our goals, initially at least, should not necessarily be for perfect coverage for all but adequate coverage for as many as can be fit within the budgeted amount.
My eight year old grandson, brain injured by his chemotherapy for leukemia, is still struggling to take a few steps six months after the injury. He receives two hours of physical therapy per week, the same amount as someone who sprained their ankle. This is with "good private insurance." Meanwhile, the CEO of his insurance company was paid millions of dollars last year. It can't get much worse.
2
Here's my question: If Warren does not yet have a plan for how Medicare for all would work and be paid for -- after running for President as a supporter of Medicare for all for a year-- how can she possibly be so certain that "costs for middle class families" will go down under her "plan" as she has insisted a hundred times, including at all three debates. She can't because she has in fact no plan -- just a slogan. Kind of makes you wonder about all the rest of her so-called "plans," doesn't it? Even now, she says she needs additional weeks to work on her plan. Here's a suggestion, Senator: Medicare for all -- with no premiums, copays or deductibles and total coverage of prescriptions, dental, even glasses -- will require a whopping new payroll tax. Period. Saying anything else is a lie.
Could you call and offer to help her? You know a lot about healthcare economics and Elizabeth Warren seems like someone who listens to expertise. Now that Bernie Sanders is looking weaker in the polls, maybe she can afford to transition from the absolutist Medicare for All position to a more Obama-ian "in my heart of hearts, I support single payer - but I know we're not ready for that as a country so for now let's..." have a robust public option or whatever. Clearly, framing is also important. It does seem like a trap to give reporters a headline of "Warren's plan will increase taxes by $20 trillion over 10 years" but if there were a way to get employers to contribute roughly what they're currently paying for their employees' healthcare premiums to a single-payer system in the form of a new payroll tax or something, perhaps it would be easier for people to see the real trade-offs.
It's hard to determine WHO in fact likes our health care system as it is. Patients get substandard health care, and physicians overschedule themselves and spend a lot of their time on the "business" end of things--and a whale of a lot of money on salaries for people whose job it is to figure out the bills for insurance companies and patients.
I'm quite familiar with these problems as a patient. But the saddest thing for me personally is that the need for employer-subsidized health care determined my professional life. I couldn't actually work at something I wanted to do (though I was qualified to do it) because of the need to take a job with a large company that offered good health insurance. "Obamacare" has apparently helped a multitude of artists and other creative people whose income tends to come in spurts. But Obamacare has not existed very long.
I remember going to faculty parties in the mid-1970s and having the same sort of discussions that now take place. More than forty years ago, and where are we now?
President Truman pushed for nationalized health insurance in the 1940s (see his State of the Union addresses). He got talked out of it by company CEOs who wanted to use health insurance as a competitive advantage in hiring veterans returning from WWII. How many more presidents do we have to wait for before having reliable insurance that doesn't depend on our jobs?
If Warren can figure it out, she has my vote.
3
This has killed her.
@Orbis Deo
Or perhaps not! Categorical statements like that with no explanation (and against facts since she is now the frontrunner because of her positions) are perhaps for Kant to make. Who do you think you are, Kant?
Again, who are these middle class people. I need Warren to exactly define on a federal tax scale who these are otherwise I would not believe an iota of what she will say. There needs to be a yardstick and not some vague middle class promises that overall they will benefit and not get hurt tax wise.
3
Excellent!
I don’t think Medicare for All will fly in this election. It’s too divisive. The best option is to expand the ACA. It’s heartbreaking to see the Democratic candidates rip each other on this issue –they should be talking about trade issues, inequality, minimum wage, Trump’s crimes, etc. And please don’t get garbage out from 40 years ago. EVERYONE has bad days.
2
"Good private coverage" is, for many if not most, an oxymoron. Yet we keep pretending it's the usual case. I don't think readers of The Times should be falling into the trap of thinking that something costs more if it comes from your left pocket, government-provided, vs. your right pocket, produced by profit-seeking private providers. Or worse, that it's "free" if it comes from your right pocket but costs something you wouldn't otherwise have to pay if it comes from your left pocket. Let's compare instead left-pocket vs. right-pocket costs for those who get the good or service.
@Mike McGuire It's not the "usual case" but it is the case for a huge chunk of the electorate. People who support single payer probably aren't going to vote for Trump no matter what. People that don't want to lose their health care might. Can we not please save the Republic before we attempt to save health care, an attempt which has always failed and may yet fail again in a Dem administration. But FIRST let's be sure there IS a Dem administration, Warren or not. Remember Obama couldn't do any better than the half-baked ACA even when Dems were at the peak of their power.
1
Funny thing is we have health insurance companies in Canada, they seem to be thriving too.
American needs to join the rest of the developed world with health care. you have the means.
2
@Michael McCrae
Yes, but we have too many people + half the population that pays no taxes. Unlike the other 1st world nations.
Medicare For All has at least a 70% approval rate among Americans. Why can't its proponents adequately explain it? Maybe stop calling it a new tax, and call it a smaller premium, with no deductible, no co-pay, no out-of-pocket costs. It's not free, but it doesn't cost as much as greedy, corrupt private insurance, and it will cover everyone, with no exceptions.
2
Renewing and expanding the Affordable Care Act, including an avenue for citizens to buy in to a public option would get my support. I'd hate to see four more years of Trump because of strident intransigence from the Bernie crowd. Didn't they learn anything in 2016? A real progressive would take the wheel and get us back on the road- not righteously drive us over a cliff. We can all imagine Camelot on that distant hill but first we need to negotiate the foggy and dangerous canyons that lie between.
3
Democrats need to study the recent loss of the Labor Party in Australia... too much policy wonk and too much change so people got scared off....Dems should stick to a values strategy, and leave the details until later...
I"m a Democrat, retired, on social security with not enough saved, but believe that our first, primary, most important goal is to retire Trump as soon as possible. With Warren and Sanders pushing for their most excellent health care plans, they are, however, putting up barriers before we are that point in the next cycle. I feel that it is foolish to contemplate throwing out the baby with the bathwater to use a cliche in the matter of heatlh care. Some have unions to credit for their good insurance (not so much in the great state of Texas), others have excellent jobs that carry the same level of health insurance, others believe foolishly that socialism is a dirty word in spite of the fact that insurance itself is a socialist idea, as are wool and aggie coops. Nonsense. Primary goal. Get the guy in the "White" House out. We must put aside these differences and concentrate on this goal. ACA works. Fine-tuning it will work. Moving in the right direction will first take a new president.
4
I'm so sick of hearing the phrase "if you like your insurance company". Who are those people? I don't know anyone who likes their insurance company, no matter how good their coverage is.
Democrats need to tell a simpler tale when it comes to Medicare for All. It should not be this hard to sell it.
What are you going to do when you retire and no longer are covered by company health insurance? Do you plan to apply for Medicare Coverage? You will age, get sick and die. Your quality of life will be dictated by the medical coverage that you have.
Medicare for all eliminates insurance companies, not hospitals or access to care provider that you prefer.
It's really is not as scary as the fear mongers want you to believe it is. You are going to be on it eventually. It's not a matter of if but when. Candidates need to keep it simple.
Why should we worry about costs to provide US citizens with qaulity medical, we have the money and no one seems to be worried about the costs to bail out the farmers during our trade war. We were never going to be able to sustain the current tax cuts.
I respect Warren for not pulling estimates out of her rear end. She's been evading the question on how we'll pay for universal coverage because her team has not yet completed and vetted a concrete policy plan. She takes opinions from top economists and respected unions to help formulate what changes will be proposed. I admit that it was premature to come out and spout her hopes without the numbers to find it - and was likely born out of political necessity. But the plan will come.
Other politicians just say things that people want to hear and then come out quietly with an earmarked proposal written by entry-level staffers. Warren is different - she really has a PLAN.
Even if Warren's policies aren't popular, they'll be thoughtful and have the common working man's needs in mind because she's built her career on making the system work for everyone. I have full confidence in her ability to lead this country out of the insanity caused by Trump and every other president since Reagan (yes, including Obama to an extent).
Healthcare is a RIGHT that everyone in this country should have access to. No copays, no deductibles, no surprise bills. You go to the doctor/hospital, get treated, and go home to your family like in every other developed country. It's not rocket science!
How do you get there? Doctors and administrations won't be able to buy 4 Mercedes and 3 resort vacations a year. Sad. How else? Everyone pays a little more in taxes except the rich - they pay a LOT more.
1
Paul Krugman writes : "I have no inside information about what led her to take that plunge, but my guess is that she was trying to protect her left flank — to avoid alienating supporters of Bernie Sanders, who have made single-payer a kind of purity test one must pass to be considered a true progressive. “
Here he goes again.
Back to 2016 where he wrote "From the beginning, many and probably most liberal policy wonks were skeptical about Bernie Sanders. On many major issues — including the signature issues of his campaign, especially financial reform — he seemed to go for easy slogans over hard thinking. “
Paul Krugman claims to be a liberal (His blog was named “The Conscience of Liberal”). When it comes to elections he turns into a Republican in disguise, as he did in 2016, where he declared “Sanders over the Edge” but “Trump is right on economics” - the only US economist of note to do so
He was wrong then, and he is wrong now
My article in PA Times, the reputable professional newsletter of the American Society for Public Administration, explains the Rubik's Cube of health care finance, and offers 4 viable policy paths. Single payer is NOT one of them: the math just doesn't work, nor will the politics, and Warren should know better and pivot to Pete's version.
https://patimes.org/the-rubiks-cube-of-health-care-finance/
and for those interested, I also have a legislative path to lower prescription drug prices (most favored nations) and other medical costs that should be part of the Dem platform https://patimes.org/supply-side-strategies-to-reduce-medical-costs/
3
Medicare for all will give Trump four more years.
3
No it won’t. My word against yours :-)
I agree with Krugman here; Warren needs to give herself some wiggle room on this issue. The reality is that there will have to be a transition, and a public option is the best way to do that. When the public option is shown to be the best option, people will naturally leave their plan and go to that. It's silly to be so strident about this issue. It doesn't work for the Tea Party nut jobs, and it won't work for Progressives.
1
You did not help her out of the "health policy trap."
You fell into one yourself and I'm disappointed in you.
You, of all people, could have presented some facts and the waste in the current health insurance system. Just the waste of resources (cash) in the private insurers high salaries and investor payments, etc. would save billions.
You showed yourself to be the moderate you are and the "incrementalist" you are.
And the disappointment you are.
You know very well that we spend twice as much per person on health care than any other country with no higher outcomes; maybe worse outcomes. You could have explained how some of those other countries set up their nationalal health plans.
You failed today Drom Krugman.
1
To all those who think we should choose a politically moderate candidate or we will lose the election--please note--we chose a moderate candidate last time and look what happened!!!!
1
The reason I like Warren is she seems to be the smartest candidate. Falling into this trap makes me wonder. I saw the trap, why didn't she?
BTW, I'm on Medicare with supplemental private insurance. I wish everyone was on a plan like mine. The way to get there is via Obamacare with a public option that eventually takes over. A well structured public option will be popular and given some time will become the dominant form of health insurance to all.
3
I'm disappointed that their is such disproportionate focus on the tax aspects, all the while barely touching on the overall expense born by the individual.
As an independent contractor, I've been paying the full cost of my own health coverage for many years. So I have a very clear view of the total expense of my coverage.
An increase in my own taxes that is nonetheless smaller than the monthly premiums I'm paying would be welcome. That provides a financial benefit to me. It seems simple.
I have to conclude that individuals with employer-provided insurance just don't have a full awareness of what is actually being paid for their coverage. Or they don't trust that their employers will shift those expenditures into salaries under Medicare For All.
You can't really properly discuss the tax side of these proposals unless you simultaneously discuss the current expenses paid by individuals or their employers.
2
@StatBoy You are correct. Box 12DD on the W2 gives some idea what is paid, but not all the insurance sometimes is reported.
There has to be some sort of mechanism to ensure that those premiums get returned to the workers, and not into the pocket of the employer.
Here is a better suggestion:
Explain what Warren and Sanders are saying well.
The cost differential of the single payer Medicare for All plan versus what the nation is paying now (computable) needs to be compared to the tax increase differential across all tax brackets.
After you have done that you can tinker with the tax rates to be payed by each bracket in more progressive manner. You can also improve the Medicare offerings by eliminating the cap on out of pocket expenses and adjusting the taxes on the top percentile to pay for the extra feature.
Can this be done easily and presented to the readers of the New York Times? Of course it can. Plenty of grad students at MIT, Harvard or any other decent economics program can do it in a week. Why it is not being done? Who benefits from it not being done? Who stops this comment from being printed in this section?
Lots of questions not to answer the basic and simple question.
4
I'd opt out of my employer insurance if the net cost to me were less (net being the premium my employer pays plus what I pay.) Remember, what is paid by the employer isn't going into your pocket as salary.
1
Medicare for all frightens people who are on Medicare. They fear they'll lose their benefits, They are afraid they will lose their social security benefits that they paid into all of their working lives. Call it something else please or it will never win the vote. How about a return to "universal healthcare."
1
All Senator Warren has to say is "it will be a beautiful plan. You'll get such great healthcare coverage. This I can tell you."
I get it, that was the other guy- the one with the best words. But Warren does know what she’s doing, she just hasn’t wanted to give the GOP a talking point they can use out of context. Personally, I think allowing the so called public option is the way to go for now, because America just isn’t ready for (gasp) “Socialism!” Of course, Trump et al have No Plan at all, so I appreciate Warren’s willingness to go after it. I just just wish she would soften now, rather than later. I do believe she would moderate her views if elected.
1
I think I understand what Prof. Krugman is driving at.
The big challenge for Sen. Warren is teaching the U.S. public to recognize that we are victims of the world's three biggest rackets:
> Healthcare and it's related parasitic industries; pharmaceuticals and insurance.
> Academia and its sister scam; the student loan atrocity.
> The U.S. government that aids, abets and pretends to regulate those rackets while operating a very active interchange of benefits with them.
That may seem harsh. but I'm certain it's probably only superficial. The devils in the details are beyond any existing audit. But, like little children, our timidity keeps us compliant with abusive authority because even if Daddy is a beast, he's the only daddy we can imagine.
As Dr. Krugman suggests, an extended transition period or public option trial might be the path to discovery of a far better daddy.
5
There are plenty of examples of single payer systems around the world, some very good, and some very bad. The US has a single payer system for folks over 65 but even that system is supported by private insurance supplemental policies. I believe that the role for private insurance companies will not be eliminated entirely as a single payer system will always have shortfalls and will not cover everything. The question is how far will a single payer system go in terms of coverage and how much will it cost in relation to our system today? Who will pay and how much will each stakeholder pay? Much like guaranteed education in this country, that system is supplemented by private schools and individual tuition payments for public colleges, universities and technical schools, rarely do we find a social system entirely funded and run by the government. I too am interested in Elizabeth’s plan, it will make or break her candidacy.
3
The huge problem with Bernie and Elizabeth's Medicare for All proposals is the clear implication that we, the middle class no less, should all pay higher taxes up front, and then rely on promises that we will see (when?) lower healthcare costs and premiums that don't just offset the taxes but make us come out better.
Who pays a roofer, a homebuilder, or any other contractor 100% up front and just trusts that they will do the job? Nobody. Nobody, not even me, a Democrat, should trust the government, even if it is well-meaning, to accomplish this mammoth, complex project without cost overruns that may eat up the promised savings. (Imagine that, a government project with cost overruns...) It's a crazy risk. It will also make those independents who have been creeping out of their safe places to sniff the idea of voting against Trump, to turn around and flee back into the forest.
The smart homeowner, and the smart citizen, should pay incrementally for incremental work until the whole job is done to our satisfaction. And that's the lower-risk way our healthcare system should be transformed.
1
It is not because a country has a universal coverage publicly founded that this country does not have private insurances pitching in for the part of the costs not covered by public insurance. At least everyone has a decent cover and can be taken care of. However, the most important thing a publicly founded healthcare system can bring is a leverage ofthe price of care thatb providers and industry can impose on people (who ultimately are the payers, not the private insurances). That the reason why in so called and despised 'socialist countries' in Europe for exemple, the price of care and cost is dramatically reduced as ompared to the US, while the health outcomes are better. How can you be against a win win situation like this? If US taxes are quite lower as they are in Europe (for ex.), in the end, when a person has either to forgo or add a sizable amount of money to pay for a health insurance ($18,000/y for an adult couple; a lot of money if it were called 'taxes'), which is just a bottom line since, on top of it you will have to pay out of pocket money ($150.00 for a visit with an IM doctor if not a 1st tier preferred provider ) for simple care (like an annual physical), it is unbearable. If In addition, all universal coverage include vision and dental care.
1
This is an excellent article, but like most others it is focussed on the cost of MFA without looking at what Medicare for All really would be like. First, it may not have any resemblance to Medicare as we now know it. Medicare, which reimburses health providers at a low regulated rate compared to private insurers, winds up being subsidized by private insurance. What happens when that subsidy is removed? Are we just saying that Doctors will just make less money? Or make it up in volume by seeing many more patients a day?
Then there is access. With no deductibles, no co-pay (and no premiums that could rise), how will the gate-keeping function be done? Will you have access directly to a physician, as most do now? Or will you have to go through a screening process?
We all know that government is famous for its efficiency and customer service (right?). Will the government close hospitals and create 'specialty centers' for efficiency? How long will the wait be for specialized care? How much control will patients have over options of care? (Private insurers are not good at that now, no reason the government will be better.)
We have an example of a government run healthcare in the Veteran's Administration. Some of the care is absolutely first rate. But in other areas they are criticized, probably justly. And they also rely on the 'private sector' for some levels of care.
All to say, we are rushing into MFA (actually Mandatory MFA) without much understanding of what it even is.
1
My husband and I are both on Medicare, which is not free, and on private insurance which picks up just about everything that Medicare doesn’t. I will vote Democrat, regardless of the candidate, but would need many more details before I would be willing to give up my supplemental insurance. Medicare for all, with the option to purchase a supplement is a much better alternative.
1
One thing I don't see mentioned in the Medicare For All discussion is that basic Medicare part B has NO out of pocket maximum. The patient is responsible for 20% of all outpatient costs with no limit, which for something like chemo or radiation can be staggeringly expensive. Basic Medicare also does not pay at all for outpatient drugs.
Private insurance, in the form of heavily standardized Medigap and less-standardized Part D policies, protects those who choose to buy it from this potentially devastating financial exposure.
I wonder, will this role for private insurance be eliminated under a universal plan? If so, will the Medicare cost-sharing structure be changed to eliminate the need for it?
1
@Carolyn O.
How about modifying Medicare to have an out of pocket maximum instead. We can adjust taxes on the rich so that the cost is covered. Did you ever think of that?
1
And one more thing: private health insurance companies are “middle-men”...brokers who complicate healthcare with their myriad requirements and processes (each “provider” seems to have their own set of paperwork that takes 30 minutes to complete at the start of the first visit). In turn, these additional and unnecessary layers of bureaucracy add costs to the system that—when eliminated—would already go along way toward lowering the overall price.
Democrats need to take Medicare For All off the table. It's is confusing to most voters and difficult to explain.
The focus should be on defending what we have now - Social Security, Medicare, Affordable Care Act and promoting investment in rebuilding our infrastructure since our highways and roads are falling apart.
We need programs to provide opportunities for people harmed by the changing economy.
We need affordable rental housing all across the country.
We need affordable college and tech schools.
People understand theses issues. The Democratic Party should own them.
BTW - removing Trump by impeachment will let Pence run as an incumbent President and will likely fuel an unstoppable fire among GOP and many independent voters.
The Democratic Party has to get this election right.
The candidates must stop hurting each other. Hillary lost for many reasons -but Bernie was one of them.
3
I had assumed Senator Warren's reluctance to put out a plan with her stamp on it was to give her room to navigate, ie. tack right, during the general election. She could move from "Medicare for All" to "Healthcare for All" recognizing that fixing the ACA could be effective in providing greater access but seen as incremental. It would avoid the "the Dems want to take away your choice in healthcare" that we are already hearing. But her opponents have called her bluff.
I am interested to read her response.
1
And, of course, it would likely be un-Constitutional to "do away" with a private industry (health insurance) while simultaneously trying to "cram" single-payer onto every health provider in the US (that's millions and millions of individuals who would be effectively be deprived of their freedom to provide their labor at the place and price of their choosing).
This fantasy is just that, a fantasy. So Liberals who so much decry when Trump trashes the Constitution need to also be careful in their own house not to believe they can harness the Federal government to compel both consumers and providers into such a program.
Did anyone else ever notice that it is only the Democrats that have to explain how they are going to pay for things, and the only time deficits matter is when a Democrat is in the White House?...
Worse, mainstream media only seems to care in these cases as well. How about more articles about how the Republicans are planning to bring down the exploding deficits created by their recent corporate tax cuts?
8
@Brian: "How about more articles about how the Republicans are planning to bring down the exploding deficits created by their recent corporate tax cuts?"
How about more articles on how our federal government has grown way beyond what the framers intended? Or articles on the unholy alliance between politicians on both sides of the aisle and corporations? How about actual fair and balanced reporting by the media? That would be a start...
1
I believe that we will eventually have single pay point system that may use private companies to administer payments. The one thing that I also believe is that the current system cannot perpetuate itself. The reason is that healthcare has long ago moved beyond a commodity to being a utility. You just need it.
If you want to keep your current, private insurance, I have a sad piece of news for you. You will not keep it no matter what happens. First and foremost, unless you have the money to flat out buy your coverage, and most do not, you are relying on your employer. Your employer can, and will, change insurers on a dime for the right amount of cost reduction. Even the large employers are getting squeezed and pushing more costs onto employees.
Second, and more obviously, you may not be working for your employer in the future. In fact, you are virtually guaranteed not to be. So you better have a pile of cash laying about to replace that coverage.
Finally, our current system is the very picture of an unstable marketplace. The inelastic demand for healthcare and the virtual monopoly power of providers creates a hideous stew where costs cannot be kept down. Don't believe it? Just look at the path of medical inflation and how it steadily eats up greater portions of GDP every year. Given the current dynamics, why would that change?
2
Because of the Hyde Amendment, banning the use of federal funds for abortions, Medicare for all will not have full female reproductive care.
This one item is rarely, if ever, a problem for the 65+ year-olds on Medicare.
4
@Joe Sabin
Yes missing in the discussions is that while the elderly entail expensive care as their health issues increase, they are not facing issues of abortion, pregnancy or IVF.
These pregnancy from prenatal care to delivery is an expensive business and IVF has become way to common for the price of the procedure.
Actually extreme end of life care for the elderly such as organ transplants for people in their 80's and IVF for the barren, have a lot in common.
We have lost all touch with death as a natural process, and that nature does not want everyone to give birth.
Not talking at all about religion, just that nature has a process that we are totally trying to negate.
If Warren is in a health policy trap, its one of her own making. If she actually does come up with a detailed proposal, the press and the public must do the work of examining its assumptions, including the details that are left out.
For example, if her proposal would eliminate private health insurance, will anything be done to mitigate the sudden financial collapse of that industry, the loss of jobs and careers and the widening economic ripples from it? How much will that cost the government?
Is CMS, the government agency in charge of Medicare, capable of taking over the management of healthcare for the entire population? Remember the ACA exchange debacle? How long will it take to get it ready?
How will the politics of health care change when the government becomes the de facto provider of health care services? Will it lead to impossible to meet demands for mental health services, specialty services and services in historically under served rural and urban areas? How will that affect cost?
2
@PWR
Yes the ironic part is that many of those health care jobs are in depressed areas and may be the only jobs left in these areas.
So they promise you will have free healthcare but you will not have a job.
Same with cutting military spending to pay for healthcare, many of those employed by the military are out of high school and with no additional training.
Those bases that we have all over the world provide jobs for those that come from many of the depressed areas of the country.
1
Many of the commenters here respond to Krugman by arguing the superiority of M4A as though that superiority guarantees electoral support. It doesn't! That superiority doesn't matter if people are fearful of change and what may or may not happen. For example, people can be excused for thinking that requiring employers to pass along the reduced premium cost to employees dollar for dollar will not happen as proposed. Any failures in a system can mean disaster for a family and assurances by candidates that all will be well are seen just like all promises by politicians. Consequently, M4A who want it is a winner and mandated M4A could produce a Trump reelection.
1
The main problem: those families with "great" private insurance do not see the costs associated with their coverage. It's buried in their paystubs and not something that they have to think about.
If people are considering the savings Medicare for All would accomplish, then that average of $20,000 or so per family needs to be part of the discussions. Will employers freed from these obligations under Medicare for All add that money to each person's paycheck? Not likely-but that money is what makes or breaks a public option, that and cost containment.
WE are, in 2019, spending close to $4 trillion (with a 'T') on healthcare in the US.
For that $4T we get a health system which is partially excellent, partially mediocre and for some, completely missing.
Should we not be framing the conversation around how to best deploy that $4T to the benefit of all?
There are, of course, many additional facets to the argument: For example, could we enact best practices that might enable us to cut that $4T down to $3T or even less? After all, many countries do a much better job than we do (from an outcomes point of view) and spend less than half of what we spend per person.
If we are able to take away the loud voices, the lobbyists, the inherent waste and political nonsense, there is an answer here. WE can certainly deliver excellent healthcare to ALL of our citizens for no more than we are spending now and probably for quite a bit less.
It is a testament to the putridity of our politics and the ineffectiveness of our legislators that the rancor drowns out the reality.
1
Excellent article. One main point is so important - that Warren is standing where she is currently on the health care issue so as not to alienate Sanders' voters. We have been here before. She is wise not to alienate Bernie's voters until, late in the game, he inevitably bows out. But this strategy could cost her. The process - of eventually going to Medicare for all, will take time, maybe decades. We can't go in one election cycle (and let's hope it's only one) from Republican policies of lowering taxes for the wealthy and undercutting healthcare for the Americans who need it the most to a wealth tax and Medicare for all. This is why it could be that the progressives will not be elected this time around. I think Elizabeth Warren is spot on about everything. I am all for the wealth tax. The inequality in America is severe and worsening and is a threat to our democracy. But this nation, so large, and so bitterly divided right now, needs to be turned slowly. I hope the Democrats can find a more middle ground candidate who can chart the course to the future, advised by Warren and Sanders, as we return to a real American government - of the people, by the people, for the people.
And let's not forget that Medicare part B covers 80%, leaving the remainder for you and your (private) medigap coverage, if you have it. Has this been factored into any of the analyses?
I'd love to think that something like this could work well, but it's long to be a long, hard road.
I really like my private (employer) coverage.
3
I am overwhelmingly frustrated that we have spent three debates discussing the exact same thing on health policy, while the GOP health policy is the following:
1. Let healthcare companies do whatever they want.
2. Do not help our citizens at all.
3. In fact, let's hurt them by stripping funding for Medicare and eventually Medicaid by transitioning to gloriously vague "block grants"
Can we please return to earth, where the Democratic party has ideas and policies to fix our country, while the GOP offers less than nothing: they have hatred for our neighbors and endless spite for science.
1
Please tell me why universal medical care should be free for all, including upper middle class earners. Anything free is going to be misused. Establishing a system of fees based on income and limited to avoid financial hardship could probably go a long way to reducing the overall cost to the nation of universal health care.
1
@Drusilla Hawke. It isn't only patients who get frustrated and cheated by the illusions of private health insurance. Many physicians also know the agonies of trying to do what's best for patients in the setting of an insurance system built on incentives to avoid payment.
This doctor recognizes that elimination of private health insurance will likely come with a reduction in fees available to practitioners and hospitals. So be it. Our payments will no longer require multiple billing clerks, denials of benefits, etc. Thus, our overhead expenses will drastically go down. Our focus on patient needs, on caring relationships, will go up.
As private insurance goes away, the public will no longer be bombarded with expensive, outrageous advertising for inscrutable plans like Cigna Chartreuse or Anthem Aquamarine. And we'll no longer be obligated to fund the bloated, duplicative bureaucracies of for-profit insurance.
Thousands of physicians and medical students have joined Physicians for a National Health Program (www.pnhp.org). We look forward to a universal, comprehensive, simplified, tax-supported system in our professional future.
4
My main question is this: If 48% of American households have no federal income tax liability, does this imply that in a Warren/Sanders model that the other 52% of American Households will be paying for 100% of the countries healthcare costs?
3
@Mark
Yup.
So far in the health insurance/health care debate, one never hears the demographic facts about Medicare. Last I heard, 10,000 citizens PER DAY turn 65 and become Medicare-eligible. We are barely halfway through the baby boom so won't Medicare (if it not already is) become the largest health insurance provider in the country - AND will require substantial new public funding and improvements. Yes, many who can afford it buy "Advantage Plans" on the private market to supplement Medicare B. Safe guess the private market will be around and I'm sure United Healthcare is not worried. Finally, once a viable publicly funded alternative is available to all, how many employers will jump ship and no longer offer group health insurance as an employee benefit?
2
How about cutting the military budget to pre-9/11 levels? It would probably fund medicare for all and still leave a huge chunk of money to keep the military-industrial machine going.
1
I am not expecting Elizabeth Warren—or any candidate, for that matter—to fully and completely explain exactly how they would pay for a “Medicare-for-all” system. I just know that it’s time we make this change.
Each of us (corporations, too, as they are “people,” right?) should pay what we can toward this single-payer national system through a highly progressive platform.
More so, we must eliminate bureaucratic waste and redundancy; there is too much paperwork (we need to go fully electronic on a blockchain) and too many paper-pushing positions.
@Andre Hoogeveen If you're saying, in effect, we've just got to do this and we'll worry about how to pay for it later, you must have a lot of money to burn. Most people don't.
As for the idea that having the government run our healthcare system would "eliminate bureaucratic waste and redundancy", that is truly the stuff of comedic genius. I would submit it to Jimmy Fallon, Stephen Colbert, et al. for their monologues.
1
I’m a lifelong Democrat and I will not vote for anyone promoting Medicare for all. One size rarely fits anyone. I do not want Trump to win re-election and I believe Warren/Bernie’s position will be the reason. Traditional left organizations are balking at it. Warren claims to be a Capitalist but is promoting a socialist policy. There are other ways to solve the health care crisis besides destroying for-profit health insurance companies. I remember when my insurance company was a non-profit and it worked well. Imo, a better solution is to have a public option on the ACA. Allow people 50 and older to buy into Medicare. If only you could moderate this stance Lizzy, you would have the nomination. Buy I fear it is already too late.
3
This specific article is a delightful setup for a detailed program that will absolutely have critics (this is America!) but likely be acceptable to most Americans. It will NOT be the ultimate solution because it needs to be polished and reworked in Congress first, and that will not happen until it is approved by voters and Ms. Warren is elected. However it could be the tool that moves the presidential chair from a the golf club to a live health program we all can use. And one we can complain about to our friends.
Health care in the USA is too closely tied with the idea of a 'Job'. People quit jobs and move to another. Health insurance has been just one of those offices that you go through on your first day on the job - listen to an insurance administer, sign a few papers, then go on to meet more of your new co-workers.
Tying health insurance to your job is fine if you work for the same company for a long time, and you like the health insurance that the company provides. This is the 'Big Company' picture. If you choose to work for a smaller company, then the health plan coverage might be more limited. A small law firm, a group of computer programmers who have joined together for a project. A successful used car salesman going off on his own. A health care worker with a number of private patients. These are increasingly a part of the employment scene, the 'Gig' economy.
For these smaller entrepreneurial work environments, it would be better if the worker could have their own health insurance, which would be 'portable' as the worker moves from job to job.
In many cases, this has been done in the past, if one family member has a steady job with a 'family plan' health insurance that covers everyone. But, what about if you are not married? What about if you get a divorce? Does the 'family plan' split too and cover both parties? Not likely.
Chopping Health insurance free from employment has a lot of advantages, but it is a 'change' and change is always scary.
3
@Robert Gustafson
This has always been the central and often undiscussed issue with private health insurance. Without personal portability, issues like maintaining covering for pre-existing conditions become real problems. This current system also forces this "one-size fits all" system for large corporations, which doesn't match reality.
Ideally, the tax credit offered to employers for providing health insurance should be extended to individuals. It's a simple way to make individual insurance economically possible, and it will solve a myriad of the problems that 1950s wage controls caused.
Thanks for hitting the nail on the head.
It is an absolute no-brainer that Medicare for all has no chance-zero-of passing a Congress regardless of its partisan makeup. You haven't seen anything in way of lobbying until the drug companies and the AMA roll out their big guns and big checkbooks to oppose it. MAYBE a public option is an idea that has a chance of passage, and would represent real progress. But why in the world, while Trump roams the country like a wild elephant, would a Dem propose a program that would take away an employee benefit valued and appreciated by a huge swath of the public - i.e. the voters. This is a completely unforced error on Warren's part and the sooner she abandons it gracefully the better off we will all be. She has lost sight of the fact that Bernie Sanders is NOT the target. Figure it out Senator. NOW, not next October.
3
Enhanced Obamacare? Isn't that essentially what Joe Biden's plan is? Along with a public option, which Mr. Krugman also favors?
Curiously, no mention of Mr. Biden or his plan by Mr. Krugman. A plan that appears to be consistent with Mr. Krugman's position regarding health care and as way of expanding coverage.
If Medicare for all isn’t going to happen, if even under some improbable scenario it does it will be be a plan sent through Congress written largely by Congress, if under all these scenarios the answer of Warren will be irrelevant, why is the question so important?
No candidate who doesn’t want Medicare for all has a plan, even in abstract for universal coverage. This includes all of Sen. Warren’s detractors including Sen Klobacher and Mayor Buttigieg. Why the free ride of having no plan to do anything?
1
@Edward Brennan
Literally, 6 seconds into a basic online search yielded actual facts as to Amy Klobuchar's health care plan:
https://www.klobuchar.senate.gov/public/index.cfm/health-care
https://www.nextavenue.org/amy-klobuchar-health-plan/
My Dad, a retiree from GE, was irate when GE dumped its pension medical coverage and forced everyone into Medicare. He joined the Tea Party and became a Trump supporter. But when he got very ill and had multiple hospital stays and treatments, then passed away, his combination of Medicare and a private insurance plan that his GE pension helped him to afford left his widow with not a single medical bill. I repeat: They never had to deal with a single bill. Sadly, he would probably still want to vote to overturn Obamacare, just for spite. But at least he and his wife were able to benefit from it.
@alcatraz This makes no sense. What did your father's "combination of Medicare and a private insurance plan" have to do with Obamacare?
The problems outlined by Dr. Krugman are exactly the reasons my wife and I cannot support Elizabeth Warren nor nor donate to her campaign.
It would appear the distinction between the transition to single-payer Medicare for All and Medicare as a public option competing with current private insurance plans is politically large. But, practically small.
3
The case against medicare for all is not merely political. It is also economic and realistic as well. Medicare does not even pay now for most of the care people would need. There is no medicare for maternity care, pediatrics, adolesecent, etc. Medicaid does pay this, but the states have many different programs and requirements, many contracted out to private insurance. You cannot go from nothing to something while just throwing something away. That is not good business, politics, or anything else. Bottom line, health care providers (from doctors to janitors) have to be paid and this requires that costs be less than income. Current medicare and medicaid rates pay far less than private insurance. Practices can't survive on those rates alone. So saying we are going to close practices because we don't like CEOs of insurance companies isn't merely a political question. It is a business questions. The numbers just don't add up. The solution is a phased approach. Negotiate with drug companies, remove the requirement that Medicaid pay for any drug that treats a disease (allow it to be based on trials and actual improvements versus cost like every other nation), and use the commerce clause to allow for a standardized billing and approval process for claims. These reforms alone can reduce costs by 20-25% given our relative cost of meidcations and administrative overhead. Expand CHIP and medicaid to cover all children until age 18. These simpler reforms can make the system better.
2
The other problem is union members whose unions have negotiated extraordinary coverage. Some of the unions self-insure with a reinsurance contract. Democrats cannot win without the enthusiastic support of unions.
The public option makes the most sense (politically) with premiums governed by income and assets. No tax increase. No fear of flying a new aircraft.
I have Medicare and it is great. All of my doctors are covered by an Advantage program so I switched. I don't even need referrals to see a specialist and the only co-pay is for use of the ER. Most people don't have that kind of choice available. "Choice" is the operative word.
1
My memo is more for Bernie than Elizabeth Warren.
Krugman is correct; either candidate will have to compromise to get Medicare for All which is not limited to the all out single payer, get rid of the insurance industry model.
In most matters, Bernie's old Testament prophet stance is justifiable but not his insistence on a clear the decks of all private insurance model. If he is going to get the nomination, he must convince people he understands he cannot govern without some compromise. I know he can compromise, as happened in the matter of the good Veteran's legislation he and John McCain got through Congress. Compromise will be essential if we are to have Medicare for All.
Bernie is correct in saying most people love their private insurance until they have to use it for a very expensive illness. That's the moment the green eyeshades find ways to deny or limit coverage.
Folks like me, however, who already have Medicare, don't face such a risk with their private supplementary insurance
because the insurance company's exposure is far less.
That suggests a compromise, Medicare for All as we have it now with two changes A) Medicare negotiates drug prices and B) Sensible limitations on deductibles and co=pays. Phase it in by age groups and provide more funding for Medicaid for those who cannot afford supplementary insurance.
The idea of fixing Obama-care is illusory. Trump has weakened it and, moreover, may succeed in undoing it in the Supreme Court.
I don't know anyone who can afford out of pocket costs of medical treatment if he or she becomes seriously ill. So, the big problem is how to get those cost down to earth again. It will be a job because many have a dog in the hunt. The states and counties, not to mention cities and the federal government are there and they need to get out and take the non-profits with them. Senator Warren should back off until she can get a grip on people's real attitudes. Its not a issue to play with.
2
Mr. Krugman writes "(n)ot many people love their insurance companies, but that doesn’t mean that they’re eager to trade the coverage they know for a new system they don’t." But those 'lucky' enough to have private health insurance paid for by their employers, unless they are represented by a strong labor union, have no say in the sort of private insurance coverage they are offered by their generous (?) employer. That employer chooses whichever private insurance plan offers the lowest cost to the employer. If Medicare is offered as an option to all, employers not bound by union contracts will simply cancel whatever private insurance they offer to their employees. Many do this already when an employee reaches age 65. So, for many people currently covered by employer-sponsored private insurance, they will automatically be pushed into Medicare if that becomes an available option. They will not have a choice. That choice will be made for them, by their employer.
2
While I basically agree that universal health care would be the best in an ideal world, we do not live in an ideal world. We live in a pragmatic world. Among the current candidates I see Mayor Pete and Amy Klobuchar as the pragmatic realists that are promoting a public option ("Medicare for those that want it") as actually doable. No matter if the Dems take the White House, Senate, and retain the House, they will not have enough votes to actually do what Bernie and Elizabeth are proposing. And, if either one of those is the candidate, you can be sure the Repubs will attack them for "taking away" the choice, even though such a program would actually give the voter more choice of providers. And, in that light, how much choice do those getting health insurance through their employer actually have?
1
My guess is that if we offered a public option (i.e., Medicare for those who want it), over a period of a few years (maybe 5, maybe a few more), most people would migrate to Medicare. It really is better than private insurance; it's just that the people on private insurance don't know it yet. As this migration occurs, many private insurance companies will become unsustainable and either close down or eliminate their medical insurance component. We'll end up with real Medicare for all. But it will take awhile.
2
And how you will pay for this migration in 'while'? Of you end up with most people in the public option, you better have plan how to pay for all these people.
1
Republicans are great at scaring people as they have had so much practice. They would have a field day scaring the people over Medicare for all. I can just hear it now. The only thing I care about is electing a Democrat. They'll also scare people about opening the door to immigrants and refugees. What about paying for all the others freebies Sen. Warren is also proposing? Even as a liberal Elizabeth Warren scares me. I am old enough to remember George McGovern who was also very liberal. I believe the only state he took was Massachusetts. I'm sure Ms Warren would also take MA that liberal bastion where I grew up.
1
@amp Republicans will say the Democrat wants to take away your private insurance, regardless of who it is and what they propose.
They lie for a living.
If the Democrats have the votes, and that's a very big if considering swing state Dems, there is an argument for radically changing the system in a irreversable way to avoid subsequent Republican death by a thousand cuts.
But I agree that it's best to avoid medicare for all, simply for the reason that the vast majority of Americans don't know their private plan is dreadful compared to the coverage in any European country. Or they make an amalgam of insurance coverage with the quality of their doctors.
1
Ms Warren can play by the same rules Mr Trump did and simply say that the doctors will pay for medicare for all.
i think a new and improved ACA would do the trick and how about a buy in to a public option? and of course if the democrats don't take the senate and keep the house, it's then a moot point. this democratic infighting and the litmus test imposed by the progressive side of the party might result in a repeat of the 1972 debacle which brought us richard nixon yet again. i guess i am an incrementalist...
2
After spending time in Canada and having friends and family in Britain and seeing the way that both of those countries look after the basic needs of their citizens – particularly in regard to health care – and seeing the way America treats its sick and elderly, I sometimes wonder if we would be better off today had Britain won the Revolutionary War.
4
As an over 65 year old, I have access to Medicare. With my present income it costs me upwards of $10000 a year in reductions from social security and premiums, co-pays, and deductibles for parts B and D. So it isn't a panacea but it is a predictable expense. The major advantage seems to be the corralling of the list prices charged by hospital systems to something resembling reasonable charges. The insurance companies also have Medicare Advantage programs which are heavily advertised showing, I believe, that they are a profit center for the industry. These programs offer no premiums, co-pays or deductible with incredibly expanded coverage. If an insurance company can do this (must be a catch in there) surely a non-profit organization like the federal government can do it too.
1
@Elwood The catch is that the Advantage plans are subsidized at a higher cost per person than "original" Medicare.
1
What happens if you get laid off?
What happens if you get a different job that doesn't provide insurance?
What happens if you want to start your own company?
Nothing---under a universal healthcare system you'd still be covered.
Not the case in system we have now.
2
The manner in which the Urban Institute financed analysis of Sanders' Medicare For All plan is presented in the public square amounts to disinformation. What one hears is an increase in spending of 32 trillion over 10 years. This is not what the analysis says. Read it! Under their assumptions and methods NHE increases 16.6% over 10 years. But they include a lot of factors leading to increased spending and few mitigating factors. It's a prediction valid under their assumptions and methods and might be treated as a "here's what to watch out for" but predictions are never congruent with reality. And the media summary hyper simplistic "increase" of $32 trillion is profoundly misleading.
2
Wouldn't the argument for subsidized health coverage be easier if we were using a national asset to pay for it. Norway sells a tremendous amount of oil and pays for their social insurance programs with those proceeds.
Using taxes for this sort of program turns it into a welfare program. A successful person earning $1MM per year may pay $100K for their health insurance, a middle class worker will pay $20K, and an unemployed person will receive a $20K subsidy.
Rather, the Federal Government should open up more land and offshore areas for wind development, charge market-based fees, and use those funds to pay for national insurance. This makes no one person any worse off.
I love my private insurance. I love my HSA. I love market incentives to stay healthy (maintain healthy weight, keep insulin levels under control - Type 2 diabetes drives much of our chronic illness expenses). But, if one wants to make a moral case for charity, that makes sense. But the charity from the government shouldn't come from making person B worse off to help A.
I believe Andrew Yang could find a solution, wringing waste out of the government and finding new sources of revenue to pay for new spending.
1
And how do these 'market incentives' work, considering the number of obese Americans with type II diabetes? It is funny how people could claim with straight face that superiority of the system that is most expensive in world, and yet doesn't cover every one and produces mediocre result.
3
@yulia Currently, there are few market incentive to maintain good health. It is illegal for health insurance companies to charge a different price based on one's health (cheaper coverage for healthy people, more expensive for unhealthy).
Life insurance and disability insurance (my wife has to buy additional disability insurance to cover her physician income, corporate policies max out around $120K) are priced based on risk (risk = probability of illness x severity of illness).
The closest thing we have are HSAs, which allow a healthy person to self-select into a cheaper insurance plan (with a higher deductible) - knowing that it is unlikely they will incur high costs. Then I get to save a small amount of money, invest it in the market, and if I actually have to incur my high deductible I can reimburse myself.
Health care spending can be binary. For young and/or healthy people, costs are generally very low. High costs are from chronic illnesses and end of life care (I may be less willing to be on a venalator in the ICU for 20 days if this means I am not able to pass on to my kids the full amount of my HSA).
1
@yulia
My Dear Julia,
I am impressed with the quality of your comments and questions. I want to thank you for them. You get them published (I usually don't). It is sad that few people recommend them. I always do. Thank you.
1
Easy:
Offer a public option, however, bring back strengthened ACA regulations on insurers that stipulate higher minimum levels of coverage, lower maximum deductibles, no denial or higher rates for pre-existing conditions, etc.
Basically don't allow private insurance companies to offer 'garbage plans' by enticing consumers with unrealistically low monthly premiums.
Once the ability to price gouge and deny benefits is removed from the private insurance market, it will shrink if not become almost non-existent all on its own.
1
The health insurance will fight tooth and nail of these regulation, saying that they will go bankrupt because the health cost.
1
@yulia
The reality is that they wouldn't go bankrupt, they just wouldn't make the same amount of profit they do today that lines the pockets of their executives and shareholders.
For that reason, they'll fight tooth and nail.
1
@yulia
Exactly! And that is why the center right Democrats (Biden, Buttigieg and Klobouchar) backed by "theorists" like Krugman are fighting for the Medicare for whomever wants it. They know once it is an option, private companies will get what they want through what is known as "bribes." PACs, lobbyists, disinformation commercials, denials (think J&J full page ads in the Times claiming there is no asbestos in the talcum powder until it was proven otherwise, those ads are still not retracted by the Times who published them for big cash).
This comment won't be published with almost certitude but it is a free country, I can waste my time.
I do believe that one of the arguments that we need to make regarding Medicare for All is not just how it promotes the general Welfare by improving people's health, but how it also works on other Constitutional principles, such as promoting domestic Tranquility. Simply put, our laws are not supposed to drive us crazy.
Also, there are two points that we keep forgetting in economic analyses:
1) one reason we have fewer tourists from various other first world countries, and currently have more expats, is our patchwork health insurance system. With Medicare for All, more tourists will come to the US...
2) ... and if they get sick or injured, we can be part of an international health compact that would allow us to be reimbursed for some of the care received by our visitors.
Our models may need some tweaking, in short. I'm not sure what we'll find when those factors are included, but I would like to see that analysis.
I keep reading that there is so much waste in our US medical system. Can't we figure out a way to tax waste to pay (in part) for a Public Option or Medicaid for All?
2
@John D Marano It's complicated. In Europe, the education of doctors is paid for by taxes i.e. everyone and there is no litigation culture that drives up liability insurance. Of course there is also the aspect that doctors don't have garages full of sports cars and big SUVs there because they take much smaller margins, and there is rarely a whole team of nurses and administrative personnel surrounding a small family doctor's practice.
In most EU countries, the gross cost of a doctor's visit is therefore around $30 or so, after insurance it's free or a few bucks.
This level is not realistic in the US, it's all connected.
4
I like and respect Dr. Krugman, but this sort of double standard in the media is what helped elect Trump in the first place.
Trump can say any crazy thing he wants, including the fantasy of his nonexistent beautiful health care plan to cover everyone at lower cost, but Warren has to explain every detail to five decimal points?
Let’s start by agreeing that universal health care, in a rich democracy, must be a right, not a privilege. Then we can figure out the details from there.
5
@David I thought he was saying the opposite. Warren is the one saying she would be releasing a detailed MFA plan, and Krugman is saying that the more detailed she gets, the more she may be painting herself into a corner, suggesting that she's not open to a more gradual transition.
2
I just don't understand Americans. In all things Americans just refuse to look at history or learn from others.
Implementing a single payer National Health Service has been done over and over again across the world.
Here's how it's done:
1) bolster AHCA (Obamacare)
2) raise taxes on the 1% to re-establish the nation's finances
3) AHCA phase 2 expand Medicare, offer public option
4) review where the nation is before going full single payer
It's a 20 year process not a magic bullet. It can be done.
2
Here's an element of the analysis I've not seen anywhere:
So-called private insurance is primarily employer based and, to a large extent, paid for by the employer as an employee benefit.
The insurers are a pass through, if you will, and essentially employers are paying for the medical care of many millions of Americans. It's inefficient and profitable for insurers.
Under Medicare for All, the unintended and inevitable consequence is that employers save a huge expense. With Medicare for All, an enormous amount of money is simply taken out of the system. That's the bad news.
The good news is that if we have the resolve to increase corporate taxes, not middle class income taxes, the result is actually less cost for citizens. All current proposals let employers off the hook.
Medicare for All would give negotiating leverage to the government for both services and pharmaceuticals. The overall cost would go down. If corporate taxes were raised to an amount roughly equal to their prior health care costs, the result would be excess revenue to either improve health care or for other social priorities.
I'm not an expert, but welcome anyone, including Dr. Krugman, to tell me why this analysis is flawed.
We can have health care for all with a significant decrease in cost, paid for by corporations, who will also benefit. The only losers will be the profiteers in the medical device industries, Big Pharma, and others who have exploited the system for decades.
2
@Barking Doggerel
Exactly. The argument has been made for a long time now that this would allow our corporations (especially manufacturers) to be much more competitive in international markets.
Additionally it would open up a pent-up wave of small business and entrepreneurship since workers would no longer be dependent on their employers for health coverage, nor have to worry that a major (or even minor) illness could wipe them out financially.
While in my heart I'm a socialist that wants to see health care in America nationalized, I also realize it's not an option that's attractive to most voters at this point in time. The solution, then, is a public option available to anyone and everyone. Once people learn how cost-effective and good the care can be, I suspect it will begin to attract people to it, even those who currently think their employer-provided health plans are great. If employees were given a commensurate pay increase when they're getting their insurance from a source other than provided by their employer, the attraction would be even greater.
1
Exactly! I spent the weekend with a very close friend of mine who happens to be a surgeon and we discussed this issue extensively. She explained very clearly why "a highly comprehensive Medicare-for-all plan, similar to what Sanders is proposing, would substantially increase overall health spending, although a more modest plan wouldn’t." In other words, she said that to keep total expenditures for members of the middle class from increasing, the Medicare-for-all plan would be worse than that to which we are currently accustomed. And, if we make up the difference through supplemental insurance, those costs are not included in Warren and Sanders' cost assessments and those costs will be substantial because the group size would shrink and there would be less diversification of risk for the insurance companies. Of course, we could always use concierge medicine and pay out-of-pocket, but those costs are also not included in Warren and Sanders' cost assessments. She also explained that while there may not be "death panels," in order to keep costs down, third parties would strongly discourage patients from seeking treatments when those third parties believe that the patients have lived long enough or that the cost of treatment outweighs the anticipated benefit.
3
I am not surprised that your surgeon friends says that M4A will drive the cost of healthcare up more then current system, despite the analysis that shows it is not the case. It is very simple, with Sanders plan your friend will have to take less money, that is why he/ she are not happy.
1
@yulia Your answer completely ignores the fact that what my surgeon friend said was entirely consistent with what Krugman said in his article. I even quoted from his article. If you are going to challenge that information, I suggest that you come up with facts to challenge the quote from Krugman's article that I included in my comment.
2
@Mark Baer Krugman was not honest either, because what he quoted only the part that will be paid by the Government, not the cost of whole healthcare. It is dishonest because somebody has to pay for the whole cost, either Government, or Americans through premiums and deductibles. And under any other plan the cost of healthcare will be higher than under M4A.
This is what Elizabeth Warren's opponents should be focused on. They should not get down into the details of her many proposals. She should be challenged to tell us which ones can actually get through congress.
Klobuchar was correct. There is a difference between a pipe dream and an actual plan.
4
And which one? Obamacare barely got passed, and it hardly even made a dent in our system, just added mandatory fee for people who can not afford healthcare. Was it worth the effort and drama? If we should fight, we should fight for big improvement not for tweaks, as Amy offers.
Thanks, this is the column I've been waiting for. I think Senator Warren, given the impressive amount of steel in her spine, stands a strong chance of blasting through the GOP trap which is based on manipulating the naivete of American voters when it comes to economics. I prefer casting it in the most simple terms for people with private insurance -which would you rather have- a health plan as good or better than your current situation which you pay e.g., 6000/year, or a Warren plan which you would pay, e.g. 4,000 a year for. I realize this is over-simplistic, but we have to get to the rock bottom essentials on this issue. Also as you said, not ruling out supplemental plans makes good sense- the move out of this insane and unjust private insurance universe has to be seen stepwise. Finally, if the GOP succeeds in their plan to derail Warren, they really must acknowledge the invaluable help they got from right wing "centrist" Democrat leaders some of whom have openly sided with Trump against progressive Demo proposals. Let's not forget these wolves in sheep's clothing during Demo primaries.
A vote for any candidate who advocates for single-payer, Medicare for All is a vote for continued divisiveness and gridlock in DC and beyond. Regardless of how much you may like single payer as an ultimate goal, it's time to get beyond purity tests and accept that the society we live in is not one willing to embrace a sudden shift to Medicare for All.
6
If there is no candidate who is for the single-payer , our society will be never ready for it, and if it is ready, how we will know if we don't give the society chance to vote for such candidate?
Dear Paul Krugman,
I sure am please you talked about the OFFSET of savings VS tax but no one seems to be addressing the issue I am most interested in which is this. Eliminating Private Insurance will eliminate PROFIT and ADMIN costs making the health money pool bigger! Much bigger! Why would this not be enough to make the change from PRIVATE to MED for ALL a wash of maybe even less?
3
Along with Millions of Union Workers, I decided in my youth to work for benefits. This decision in-bred; my family was union. While Unions were hardly ever able to get us raises, they could get us better health care; etc. I'm NOT willing to give up those hard fought for benefits now. Shw will lose union support for sure with Medicare for All. I like Pete's plan.
4
I don't think Unions will be against, because otherwise they will be seen as anti-workers, who just want to expand their hold on the workers. Medicare for All let Unions to work on better pay and better conditions beside health insurance, and increase their strength to fight, because workers will not worry about their health insurance when they are going on strike
Access to medicine shouldn’t depend on whether a person can afford a gold plan or not.
3
Bernie’s M4A plan tries to cover everything, which is why it’s so expensive. By making Medicare coverage more basic, and allowing non-profit private insurers to cover the rest, the numbers would add up a lot more easily. It would also allow Warren to remove the profit from the health insurance industry without completely eliminating it.
2
My hope is that Warren will be the politician who finally is able to present the case for a single payer plan, complete with the full breakdown of costs and how it would happen. For God’s sake, other civilized countries are doing this, with better healthcare outcomes than the US. We just need to educate everyone with full transparency. The question then is whether we have the will to do it.
2
Senator Warren needs to to tell us what each and every one of her 'plans' is going to cost. We should know the sum total of what her election will cost us AND where that money will come from.
I, and I'm sure readers here, am smart enough to sit here at my computer and devise plans to fix what's wrong with America. But I have no idea how to figure out costs and more important where funding will come from except to say " somehow we'll get it from the people who have more than enough".
Ms. Warren you personally owe the American people a real explanation.
2
So, should every other politician. I want to hear how much the healthcare will cost under plans of Buttigieg and Klobuchar. Not just the Government part but as a whole .
Doubtful any of the politicians running have experienced actually having Medicare as their primary insurance. You can bet Sanders and Warren use their super-good congressional health care. If you have medicare, you'd better have a privately insured supplement to cover everything it doesn't. I don't understand why folks equate "medicare for all" with elimination of private insurance.
2
Three steps, a public option to buy into Medicare, elimination of corporate tax deductions for employee plans, which is a subsidy we all pay for, and a 20% reduction in military spending to help pay for it. Done.
About the Canadian system from a Medical Journal: Canada is one of only four Organisation for Economic Co-operation and Development (OECD) nations with a public health system where all citizens do not have publicly funded national medication insurance (the others are Israel, Mexico and the United States).1 As a result, provinces and territories have developed their own publicly funded medication insurance plans. This has led to a patchwork of medication insurance across Canada.2 Currently, the types of people who are covered and the coverage they have varies substantially across Canada. In this editorial we present the current situation using a patient example, identify the policy issues, and consider how physicians may improve the likelihood that their patients can afford their medications.
1
A public option would inevitably lead to Medicare For All.
Small companies would cancel their private health plans to avoid dealing with insurors. If not, their employees would opt into Medicare to get out from under crushing co-pays, deductibles, and surprise billings. Then larger companies would follow as they see the public option working.
Very few Americans have employer-provided health insurance with reasonable premiums, deductibles, co-pays, and great provider networks.
"The average premium paid by the employer and the employee for a family plan now tops $20,000 a year, with the worker contributing about $6,000, according to the survey. More than a quarter of all covered workers and nearly half of those working for small businesses face an annual deductible of $2,000 or more."
From "Employer Health Insurance Is Increasingly Unaffordable, Study Finds" (NYT, Sept. 30, 2019).
These beneficiaries love their employer-provided health insurance? They think it's better than the Medicare their parents and grandparents are on?
Really?
3
Oh? And who thinks that the health insurance companies are going to stand idly by and allow anything close to a 'single payer system' happen? These massive insurance corporations have a 'cash cow' in hand, raking in huge profits for the top executives and their investors (between 35-40% of every dollar paid for in premiums). They also contribute millions (if not billions) to politicians who do their bidding in Congress. They paid over $52 million for TV ads against Obama's single payer idea to the point that he finally capitulated and let Big HMO write the Affordable Care Act with new advantages to citizens (cover pre-existing conditions, cover kids at home to age 23, etc.) yet even more provisions that benefitted them. It's unfortunate but realistic to recognize that changing health care coverage in the USA to be less expensive and benefit everyone is going to be an uphill and on-going battle. I applaud those who are willing to grab their shields and spears and make the effort, as their 'enemy' is not going to give up easily.
4
Thank you Mr. Krugman. As usual, you have expressed the issue at hand in straight forward and an easy to understand way.
Elizabeth Warren has led a disciplined campaign allowing her to rise steadily in the polls. However, reaching and holding the top spot seems illusive. She is trying hard to win over Bernie's supporters, which is difficult because like Trump, Bernie has a cult-like following. Perhaps the time has come for her to rather go after Biden's people, as Democrats increasingly worry about his ability to beat Trump.
With the recent turmoil of daily breaking news, I sometimes switch to Fox, just to get their take on it. But I am always astounded that they are not covering the latest crisis at all. They are invariably talking about the two Bidens, the evils of socialism or homelessness in California. Democrats have to come up with a good argument for limited socialism.
1
@Jill: The Europeans call it Democratic Socialism, but the American right wing has co-opted the discussion using a combination of rugged pioneer individualism and shouting down any collective effort as communism.
3
@mlbex
Daily egged on by Fox News, so called socialism is always likened to the Venezuela situation. It's as if none of the commentators have ever been to Canada or Europe and seen democratic-socialism at work.
1
First, there will always be a place for private insurers in any universal health insurance plan that is implemented. Many people are missing or maybe purposely ignoring the fact that most large corporations and even many small businesses are self insured and pay insurance companies to administer their employee plans. According to the Deloitte Analysis; Self Insured Benefit Plans cover roughly 84% of all private enrolled individuals are covered by such plans.
https://www.dol.gov/sites/dolgov/files/EBSA/researchers/statistics/retirement-bulletins/annual-report-on-self-insured-group-health-plans-2019-appendix-b.pdf
So, in reality after considering the US population insured via Medicare, Medicaid, CHIP, military or Veterans plans, and self insured plans there is but a very small market left for what is truly the private insurance market. The majority of the health insurance corporations make their profit by acting as intermediaries. CMS actually contracts with insurance companies as intermediaries.
So, the insurance companies’ roll in healthcare will not be disappearing.
1
Let's drop this obsession with Medicare for all. ¿Supplementary plans? You better have one. 80% of a lot is not enough coverage. ¿Include new conditions? Only sleep-apnea.
It would be far simpler if the Federal Government adopted a health plan similar to Canada with no premiums or deductibles. People could argue that this compromises healthcare by increasing wait times and eliminating/reducing some procedures.
Insurance companies want to make a profit and would rather cherrypick their customers, to eliminate nasty surprise. They'll shove it off on everyone else by denying coverage to some potential customers [pre-existing conditions], dropping customers they deem to have pre-existing conditions and raising premiums and deductibles].
Health care is a right. Choice is of no use if you cannot choose health.
American corporations are famous for two things: fobbing expenses off on someone else, and getting the government to do what they want. So why do they still pay for their employees' health care?
The obvious answer is because they want to. Otherwise they wouldn't do it.
So why do they want to?
They do it because it gives them control over their employees, and they consider this control worth the price of premiums and administration. As an additional bonus, it creates a headwind for startup businesses who might compete with them for market share and valuable employees.
Consider these phrases you've probably heard before: "The pay isn't that good but I get great benefits." And "I can't quit this job because my family needs the health care."
To unravel the health care mess in America, you'll have to take this valuable asset away from corporations and give it to employees. When that happens, expect a lot of churn in the job market as employees take more risks to seek better pay and working conditions.
4
I am very receptive to single payer on the whole. But I think it is incorrectly imagined to be a panacea.
First, the reason for high medical costs in the US is primarily the high salaries of health care workers. Costs would likely be lower under a single-payer system, but largely because doctors and nurses would earn less. The profits of health insurers are not large relative to the size of expenditure on health care. Administrative costs might fall but would not remotely disappear under a single-payer system.
Second, don't expect huge health gains. Health insurance has shockingly little effect on life expectancy. The reason people in Japan live longer is that they walk places and don't eat like we do.
Lastly, administration of health insurance by a government which is Republican half the time will sometimes mean coverage that the Republicans want, e.g. no contraception or very high deductibles. Many people might prefer to still have private insurance as an option in that scenario.
4
Medicare as it exists today includes private supplemental insurance for those who want it and can pay for it. Why on earth does anyone think Medicare for All must by definition eliminate private health insurance? Sanders may think so, but Warren should not.
3
I watched the Canadian Election returns last night for 4 hours.
NOT ONE PERSON SAID THE WORD HEALTHCARE.
Can you imagine? There is no better argument for Single Payer than watching a show on politics for 4 hours and not have health care mentioned. It isn't an issue: the system works and is far cheaper than the US system.
4
As much as I favor a single payer health care system I believe Warren is in real trouble with this. This is far too complicated a subject to adjudicate during a campaign in our short attention span and disinformation era. But some suggestions...
First, she needs to make people understand that while "taxes" would rise that would be offset in whole or in part by no longer having to pay premiums to insurance companies. So the cost for a Medicare for all could be called a premium, not a tax and it might not be all that different from what we currently pay for health care.
Second, she needs to acknowledge that funding the uninsured who won't be able to pay will add costs for the rest of us. How does she intend to pay for that?
She needs to do detailed honest math to the extent she can. Granted that one of the benefits of a single payer, cost control, will be hard to estimate. But voters need to understand how costs and coverage will compare to the current system.
This is going to be exceedingly difficult during a campaign, hence my pessimism for her success. IMO, this sort of thing needs to be debated and implemented by an incumbent, which I guess is Warren's Catch 22.
1
Two points.Can anyone say what the true cost of medical really is?Ever read an EOB? Usually a provider receives a payment that is less than half of what they billed.What's the real cost?
If Medicare For All is so frightening,then why do so many people look forward to the day they're eligible for Medicare?
3
@TJ
Because they don't know anything about Medicare and think it's free.
Americans love free, just like toddlers who believe in Santa Claus and the Cookie Monster.
Already, at the outset of 2010 ACA, Obama added 30 million able bodied Millennials to Medicaid rolls such that 50% of all U.S. births are now paid for by taxpayers instead of those making all those babies. As for Medicare, well, there are also tens of millions of young adults getting that govt. benefit, too if deemed broadly disabled or with a specific disease.
Warren and Bernie need to be specific and honest about who pays the tab now and who will pay even more under their vastly expanded mandated govt. only plan(s).
In the US we are now spending $ 10,000 per person every single year for healthcare. That means, on average, every person has a an $ 800,000 lifetime liability for healthcare alone. This is obviously a mind blowing amount, with the first conclusion being that complete Government "involvement" is needed.
Senator Sanders is exactly correct that overall we will not be spending any more on any medicare-for-all at $ 30 trillion over 10 years than we are right now, which is $ 3.3 trillion every single year.
All of our Democratic candidates are very much on the right and responsible track for universal coverage - especially since the only Republican concepts involve the elimination of any government role at all.
2
First, as Prof. Krugman surely knows, even the UK with its NHS has a supplementary or alternative private insurance which people can use to have better access or special therapies. Warren would outlaw ALL private insurance. Second, I want guarantees that Medicare for All won’t kill medical research by drying out funds for pharmaceutical companies. It is strange how many people think that the only issue in healthcare is access to what already exists rather than developing new and better forms of treatment. With this mindset, we would still be doing bloodletting instead of chemo. The future belongs to personalized and gene-based medicine. Such medicine is expensive at first. Unless the government subsidizes it, how are we going to have a cure for Alzheimer’s, aging, or intractable cancers? And how will the government subsidize it if Medicare for All is projected to eat up all of its budget?
Oh those evil journalists? "badgering" Warren to explain something she promises to deliver.
2
Phase it in over 8-10 years.
Maybe have the States run it, like the Provinces do in Canada. “Medicaid for All”
Get rid of “single-payer” moniker.
Change name to “ AmeriCare for All” or “Americaid for All”
3
Paul, back when I’d make sure my Crook-lock was on the wheel of my ten-year-old car on Mem Drive, to make sure my car’d be there the next day...
Paid ~$50/month for the phone – including unlimited calling in MA...
Today, pay a couple of times that – for several phone lines and two internet connections...
And ~1,000,000X the baud traffic...
Decade later, got a pair of 17” color TV’s for $299 each – $50 extra, to get touch-tuners...
Today, pay a couple of times that – for 75” 4K TVs that have 100X the computing power of my 1st PC’s...
More relevant, DNA sequencing – which is almost agnostic to plant or animal, let alone human or not human – has dropped in cost by 1,000,000X in the past two decades...
Sooo – a 1st step in fixing our sclerotized health-care system could be to completely de-regulate non-invasive diagnostic technology...
To wonkishly split a couple of hairs – e.g.:
> Blood-drawing is not “invasive” – to the extent that the draw is no different from what’s done today
> Ionizing (aka x-ray) imaging – or any sorts of tracers – are invasive...But MRIs and ultrasounds are not
Let the market go from there...
Trying to fix HC without grokking the STEM-based fundamentals'd be like the mayor of Cambridge edicting in the mid-70’s that Cambridge phone bills would drop by 1,000,000X per bit, by 2015...
Sooo – would suggest Liz cozy up to Andrew, as much as Bernie, in this space...
PS
She absolutely lost me today, when she threw charters under the school bus...
2
Insurance companies won't lose their fat cat position on paying health bills as long as they remain able to keep buying politicians. And while it may be that half of people work for employers that provide some form of subsidized private health care, that also means that half of employers provide nothing. And even when employers do provide coverage for their employees, they leave employees in most circumstances at the mercy of health insurers for other family members that need coverage.
Most employees, excepting those with the contract guaranteed "Cadillac plans" , have little input to the plans that employers provide, so therefore no control over coverages, deductibles, co-pays, covered hospitals and doctors, etc. As such they may think they are getting something better than they really are.
Medicare for all puts and end to all that piffle and it also removes a financial burden from employers that can affect their competitive standing in the markets. This is especially true for companies that compete in international markets where their competitors are not burdened with the cost of paying for private health insurance, thus making their products more price competitive.
2
Warren needs to get companies such as GM, sometimes described as a health care company which also makes cars, to contribute half of what it spends now on health care to government, and the other half to the workers to pay for higher taxes.
2
@George Sounds like socialism when the government tells companies what to do. Good luck with that.
1
Isn't it true that the insurance provider is the decider? The insurance provider could decide NOT to cover such and such, or to pay LESS for covered care.
When that sole insurance provider is the government, facing no competition, how can we trust that healthcare coverage? Why wouldn't the government, under economical pressures, suddenly decide to no longer cover those with pre-existing conditions, e.g.?
3
Trump will play dirty, below-the-belt, amoral politics all the way to November 2020. Purist ideologues like Warren will have a tough time fighting him if they don't show some flexibility. Transferring what looks good on paper to the voters' ears and minds, given that they'll be bombarded with all sorts of nonsense, is not an easy task. We have to get rid of Trump--that has to be the primary goal for all of us, including Warren, Biden and all the rest.
2
@JB purist? You mean like her fraudulent claims about ancestry or getting fired? Lizzie has never had legislation passed so her plans will never make it through Congress.
It's the costs, stupid! One could argue insurers are complicit with providers because more expenditure ultimately finds its way to their bottom line. But insurers are not at the bottom of America's enormously costly healthcare system. To achieve real savings you are going to have to attack the entire business model of US healthcare provision which has huge implications for thousands of businesses and millions of workers in the industry.
The same applies to health insurers whose shares are an important component of millions of American's pension plans and of course employ probably millions of people directly and indirectly. You can't simply destroy the health insurance industry. This is all quite apart from the fact that convincing the 180 million Americans who are covered by private insurers that a change is desirable.
Whether we like it or not we are where we are. Path dependence cannot be wished away. Even a Medicare public option is not going to seriously address affordability issues because it's the costs stupid. Warren has not thought this through.
2
Once again, Elizabeth Warren is not electable.
She's correct on the health care problem and consumer protection.
However, to date, her solutions are vague & simplistic -- which is surprising since she's been long presented as a policy wonk.
Once again, she's left herself terribly exposed to be seen as a hypocrite. Yes, she's not outrageous as Trump -- few are.
But when one presents oneself as a very correct person, with integrity beyond reproach -- one MUST to truly be that -- otherwise one's simply another talking head politician. In short, a person not to be trusted. Especially when they're promulgating huge, sweeping social/economic changes in America.
2
Do you know who doesn't have employer-based insurance? Small businesses. Remember when we used to say that small business is the backbone of our economy? How do they pay $10k-$20k a year for insurance? They don't, or they get sham insurance and hope they never actually get sick. While we are at it, gig workers, professionals, and most service sector employees also don't have insurance.
Call it Medicare for All, a Public Option, or any nonsense word. Give people a real option and they will gladly quit this absurd and broken system. After all, how many people over 65 refuse Medicare so that they can stay on their private insurance plan?
2
@R Rhett You don’t have a choice about Medicare. Obviously you don’t know that. Only the Feds don’t go on Medicare.
1
Yes this is a huge trap. It seems like she's backed herself into a corner. This is pandering to her base.
Most people with private insurance don't want to give it up. Will they stay home if she's the nominee? Get flexible and realistic EW.
2
I hate my insurance company! I’m so sick of arguing with them about inexplicable bills that usually arrive months after a doctor’s visit. Yesterday I got a bill for almost $200.00, a hospital charge on top of my co-pay because my doctor’s office is located in a hospital! Our system is a complete and utter mess. I’d welcome Medicare for all. The sooner the better. And I’m happy to pay more in taxes to get rid of my insurance company.
3
I'm an Independent voter, generally liberal on social issues, but conservative on fiscal issues. I don't give a flying rat about Dems' purity test, I want something that works, and I don't want pain points to be glossed over. And I don't want to leave the bill to the next generations, I don't want to devour our young.
Depending on one's position, healthcare is either a huge issue, or none at all. I suspect most people (most people who vote) understand that the need for the altruistic goal of expanding the coverage, but most of them also think their existing coverage is reasonable.
So, do I want to give up on a known quantity that works well for me, and trade for Warren's (or Sanders') M4A that we have no idea how it works out, never mind who pays for it. Warren is disingenuous in being coil about how she could fund the program, and Buttigieg is right to go after her on this subject in the last debate. She wants to be frontrunner, and she's game.
Biden and Buttigieg are correct, I'd much prefer public option than to mandate everyone to switch. I, for one, don't want to switch. Sanders did to Warren what he did to HRC, he pushes her so far left that even if she wins the nomination, she'll have no hope to win in general election. Trump will have a field day if she becomes candidate. Just the Pocahontas moniker is quite enough to tear her down. Warren, in short, is far weaker as an candidate than she let on.
5
Would you rather pay 18% plus of your income for an insurance policy that may or may not pay for treatment you need or would you rather pay 8% of your income for actual guaranteed healthcare?
Would you prefer to work for a soulless big corporation just because you need healthcare or would you like to start your own business without having to worry about healthcare?
Would you rather spend your time arguing with insurance company bureaucrats about coverage or doing something to improve your health, like going for a walk?
Would you rather your healthcare is overseen by a greedy insurance company CEO you have no control over or by elected representatives that you can vote out?
Sounds like a no-brainer to me.
1
@Adrian Guaranteed health insurance is not guaranteed health care. Try looking at the VA.
2
@Jackson My point exactly. Health insurance is not healthcare, guaranteed or otherwise.
@Jackson My point exactly.
Shame on you Paul Krugman! Your comment about the argument against medicare for all being "all political" does not help the debate. As someone with several chronic conditions being kept alive by the Mayo Clinic I have read the Medicare for All bill of Sanders & Warren. For me the bill would be a medical disaster because of various restrictions. See for example Section 203C: Application of Practice Guidelines or Section 301: Provider Participation & Standards. This bill is way too vague to inspire any support from those of us who need specialized care and/or experimental procedures. In short, it is not about cost; it is about the quality of care it will deliver.
3
Barack Obama won the Presidency in 2008 by promising a medical insurance plan. Republicans had thought the Presidency was theirs forever. Obama didn't win because he got the support of medical insurers or rich titans of industry. He rallied the very same people who Krugman describes as not having the ability to crunch the numbers.
I'm not giving up on the good sense of American voters. The 2016 election was a fraud perpetrated by Russians, the super rich, and a fraudster. Trump is an illegitimate President. He cheated to win.
1
@cjg
Obama won because he was (a) male, (b) .5 black. Period.
There was not a sliver of light between his and Clinton's policy platforms (which Team Obama co-opted). Except she had the policy smarts, experience and legislative competence to actually get national/international policies passed that he could not and did not without 8 years of wholesale national rancor and Executive Order.
Warren is falling into the Republican trap like Alice down the rabbit hole. We knew this was coming from the opposition, but we are surprised that she is falling so easily. Health insurance is complicated, and does not fit well into a slogan. "Medicare for all" is a dog whistle term that can be used to rile up the opposition and produce untrue and slanted ads on social media. Medicare has also been changed over the years, watered down, and not really "free" for day to day health care. That is the reality. Republican strategists have no problem lying about anything, as we can see by the damage they have caused to Vice President Biden. We know from history that preposterous lies, if repeated over and over, can become persuasive and then, appear true. Conway knows that, but does Warren? Can Dems get behind a electable candidate and fight back as if this election really did matter? Are they going to allow the Medicare and health insurance problem to become mired in email type messaging? This is not an issues driven election anymore, but one about lies and truth. Warren needs to know that.
1
Her evasion was even more cunning, as if she had spent more time coming up with an excuse better than her non-existent payment program.
"I won't sign anything that raises costs for middle-class families," meaning she's ready to blame the others for her failures... Look! It's the others who came up with a bad plan!
I hope she fails here. Demagoguery cannot be allowed to continue.
HRC lost working people and the rust belt because she insulted the former and ignored the latter.
Warren risks losing exactly the same former Dems, but for different reasons. Med4All throws out insurance that many union workers fought long and hard to get, and they took Lower Wages so they could get it. Lots of these folks worked hard so their kids would not have college debt. Those kids worked while in school for the same reason. Student loan forgiveness tells those folks they were suckers, and that there responsible, adult actions were for naught. This while I encouraging others —rich and poor—to run up as much debt as possible since it will all be forgiven.
To beat Trump, we need to win back the Middle. That’s where the most votes are up for grabs.
Klobuchar. Pete. Heck, draft Sherrod Brown. They make sense. They would win back the Midwest. They would win back the folks HRC lost. They would work across the aisle. They would govern wisely and justly.
Republican health care policy doesn't exist, never has, never will. Got a pre-existing condition ? Can't pay for it ? Too bad, sucker.They hate Democrats for trying.
Medicare works, ask anyone over 65. Republicans hate that too.
Elizabeth Warren and Bernie Sanders are right, ask anyone who lives in a democracy with universal, single payer health care.
2
We offer 100% coverage for our employees and families. Sadly, we pay more money for less coverage each and every year. We would gladly make those monies available for a universal plan.
Healthcare is a big business and has a very powerful Lobby. They will not agree to fade away, that is why Obamacare was such a good start. An excellent beginning from nothing, tweaking yearly could have improved the product.
The Republicans want nothing to do with healthcare for America and a sold the naive public the concept of "freedom". "Freedom" is a good word except in America the meaning is if you can't afford healthcare, too bad.
Americans are used to their employers paying for their healthcare but in reality, that money comes from their salaries. This means that change could be possible but too many Americans are not too savvy about the marketing of issues and they parrot stupid nonsense about freedom and socialism. Obamacare is a perfect example of marketing, the public realized after the fact that Obamacare was quite good.
If Warren could show how universal healthcare could work and could successfully market the concept, she could win over the public and all employers who pay for their employees' healthcare. There are alot of "could" in that sentence. Which leaves the healthcare industry, a huge problem.
America long ago built the profit motive (i.e., rampant greed) into its health care sector. There is a lot of money to made out of unavoidable human misery, like those $35 Tylenol caps. The people who are raking in the cash are not going to let it be snatched from their hands without a nasty, vicious fight. And the politicians they pay to fix the system in their favor will be ready, aye, ready.
So a public option is probably the best hope for the millions of uninsured, and the tens of millions of underinsured, that thye won't die before their time or be bankrupted by greedsters. Still, the profiteers from the money-spinning system will fight back hard.
Let's hope the media will make a real effort to separate the lies ("death panels") from the truth this time.
Medicare for all is a loser in a general election. As a lifelong Democrat, I'm sick of watching Dems lose elections over stupid positions they have taken that will never be accepted by the general electorate and that the Dems don't even have the votes to pass even if they win. There is only one objective we should all focus on now: Trump must go.
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I'm a college student and I get private insurance through my school at about $2,000 a year. "Medicare for All who want it" would likely be more expensive since it would defacto have sicker people on it. Many candidates co-sponsored Bernie's Medicare for All bill, and now don't support single-payer. They must think we're really stupid. Bernie and Warren are the only acceptable choices for me.
Senator Warren scares me because it will be very difficult for her to beat Donald Trump. There are too many moderates who will “vote against” Warren, leaving the path forward clear for a Trump victory. This is the reality and Democrats need to understand this. People vote with their pocketbooks, or at least the pocketbooks they hope to have some day. Nothing else matters to them - not kids in cages, climate change, the undermining of our democracy, nothing. Shameful, but true.
1
The establishment of Obamacare, a foundation for national health insurance at last, was a tremendous achievement by Obama and his administration. Warren's hard-core rejection of it shows poor judgment. The canny, accomplished candidate is starting to remind me of Jimmy Carter, an intelligent person who made too many dumb decisions. A promise to kill employer-related plans is an albatross the Democrats don't need. The smart choice is to revive & enhance the ACA, which is popular.
If Warren is as smart as she seems to be, then she will figure out some way to tell people that they can keep their current health insurance if they want to. Else she's probably throwing away millions of votes for no good reason.
Warren is blowing it for the Democrats. To base a campaign on something that simply isn't going to happen may well appeal to a lot of children with no real life experience and may retain some Bernie supporters should she get the nomination but it is a total loser in the general election. I'm so sick of progressives trying to make it look as though this is all going to be so simple...just use logic and a bunch of dubious numbers and the public will fall in line. Give me a break.
To be selfish, I am on Medicare as are millions of Americans. I love it and my supplement. What will it look like and how will it affect my coverage when you dump a couple hundred million more people onto a plan you are creating...free coverage and the same for everybody. God knows how the transition will look but it is bound to be horrendous. Add to that doctors quitting and hospitals closing. I couldn't be more disappointed in many of my fellow Democrats. Are we trying to keep Trump in office?
2
Dr. Krugman, with Trump as an opponent, my dog could escape the Medicare trap. Who do you think she is running against, the man who is Medicare, LBJ, or Trump who cannot even spell the word?
If we boil down the political essence of each party, we find the following generalization: Republicans ruthlessly play for the end game and long-term goals; Democrats constantly destroy themselves and impatiently demand results over night. A president does not write the laws-- he (or eventually she) simply signs the bills that Congress sends to his/her desk. Republicans eviscerate the competition at the local/state levels, gain control of the legislative machine and wait for the RIGHT president to come along and sign bills. Trump has been the greatest gift the Republicans could ever ask for-- he is a dullard that signs whatever is placed in front of him; he has helped Republicans realize goals that have been 40 years in the making. Meanwhile, in Democrat Land, there is constant fratricide and purity tests amongst progressives and moderates, and then there is the current debacle of nominating a Democratic front runner. What the moronic "progressives" and "far left" folks don't seem to understand is that you have to FIRST get a Democrat elected as President-- and THEN you can send him/her bills to sign. This is not rocket science. If the Democrats want to actually make a difference in this country--and the world-- then they need to nominate a person that is smart, humble, pleasant, sincere and OUTWARDLY MODERATE with proposals that are easily digestible and acceptable for the masses. Once elected, they can sign whatever progressive bill that is placed on their desk. Wake up!
Whatever plan Warren proposes will be attacked as an expensive, reckless socialist gamble by you-know-who that will devastate the economy, destroy jobs, and send everyone to the poorhouse. What use would a detailed serious proposal have? The media would lose interest or spend hours poking holes that you-know-who would exploit. I’d rather she spent her time explaining why Medicare for all makes sense for the country. Get people excited about how it would pact and improve their lives. And leave the details for later. I don’t think anyone really cares about the details. Especially you-know-who.
Warren has come too far to blow this. She has the intelligence, mettle, and combative prowess to defeat Trump but she must backpedal from her Medicare for All clarion. If she doesn't, Trump will savage her as a socialist and strike fear into people that she will remove their power of choice.
Everyone has to be in the system. Otherwise it will be a poison pill for insurance to dump all the unhealthy people on the government. Just like they do in old age.
If you want to argue for an option the only one is on top of the government benefits. Everyone is in it. Anything else and you are handing the insurance companies and a republicans a poison pill to sabotage the system and show how cheap the healthy young people in insurance are compared to the sick and ill.
They do this with loans having government as the lender of last resort to dump their garbage. It’s socialism for the rich and it has to stop.
1
The proper fix is Medicare if you want it. That means if you are 55 years old and lose your job, which of course causes you to lose your employer sponsored health coverage you can then BUY into Medicare. Problem solved. Any objections to this COMMON SENSE solution?
Great advice. I hope she tries to hire Dr. Krugman and I hope he agrees.
For the most part, I respect Mr. Krugman as I respect few other columnists. But this business about healthcare seems as overblown as the matter of Hillary’s emails. I have confidence that Warren will do a good job of building on the ACA and evolving toward universal healthcare. Have we forgotten that Trump and his GOP sycophants have been doing their damndest to scuttle the ACA altogether? The Democrats are supposed to tie themselves in knots over the matter while Trump skates home free? And Buttigieg should be sent away.
Easy one. Instead of writing a check to the insurance company, corporations simply write it to Medicare. There. I fixed it for you.
1
The solution is obvious when we consider the law of large numbers. The "sale" is more difficult, but as obvious when the population of the USA considers the question, "Why did GM cross the Detroit River?" Ans: The "new" GM plant in Canada eliminated the cost of group health insurance for their employees, families, and retires. Let that sink into your bookkeepers mind. How much money do companies lose to Group Health Insurance/month? Ans: Lots
How much money can go into the Medicare/Medicaid purse as the Universal Health Care System? Ans: Lots
How many companies are offshore and would build the next generation of factories in the USA if we would create a Universal Health Care Sys? Ans: Lots
Only one question is about overall cost. The other questions involve choice and quality. When it comes to those factors, incidentally, even Medicare involves optional paid insurance (Part B and Medigap, for example). Internationally, baseline public options are usually supplemented by private options as in Switzerland, Brazil, you name it. In Europe, 25 countries basically run their "universal" baseline care through private insurers that are regulated. Those companies then supply optional add-ons.
What Warren is proposing is really more like lockstep command-and-control China, where there is serious rationing and people who are desperate for good healthcare pull elite strings, pay high costs out of pocket, and go offshore. Or just go off into the corner and die.
Warren's super-socialist (communist?) proposal to kill private insurance is unworkable and un-American at its core. Unless Warren basically ditches her proposal, she cannot win much of anything, except the accolades of Bernie and AOC for joining the leftist lemmings on their march over the cliff. I'm scratching my head about why such Dem leaders are going so hard left. Could be HRC is right about the Russian conspiracy to capture the Dem candidates as Russian assets. ;)
Let's put aside those terrible "Big corporations", for moment.
I want Warren to explain the numbers for those Millionaires & Billionaires... According to Forbes, 205 people earn $50 million in yearly salary. That is not the 1% ,,it is the 0.000001%. Now, if it is meant to refer to Net Worth...we would need to over haul the IRS. Currently, yachts, planes, stocks portfolios (not sales ) are not taxed. . Sorry Prof Warren, offering a Plan ,and now planning to plan a Plan of payment, would get any student a D.
1
I’d agree with the author here about the corner Warren is trapped in except almost all health insurance is subsidized in some way - either by business or government. And, that’s not counting the way the government subsidizes medicines, schooling and hospitals. Her Medicare for All policy may prove to be money better spent.
No one coherently argues about all theses subsidies. If the Republicans were not so hell bent on privatization maybe they could see the value of the government stepping in to curb costs. Warren’s Medicare for All may be the first step in that direction.
Business will always offer private plans for the same reason the carpet gets thicker as you ride the elevator to the top floor. (Without private insurance what will those one-percenters do?) However, this year is the first year I’ve heard that more workers will not be able to afford their company’s plan. Sadly I doubt business will care if the lowest paid workers don’t have healthcare.
I was disappointed when Obama did not allow people to buy into Medicare. Warren’s plan could do that if she would start with those 63 & 64 year olds buying in over a two year period. If that works well have 60 and 62 year olds buy in. If that works well then go to ages 55-59.
Warren does need to define her Medicare for All mantra. Medicare works. Ask any Trump voter who doesn’t want socialism. None want to lose Medicare. The Republicans don’t have a plan for healthcare. What exactly are THEY going to talk about?
1
I hope Warren reads your column and heeds your advice. If so, she could be unstoppable.
Just relabel the "Public Option" as "Medicare for All";
The problem is explaining this to the Deplorables.
The Propaganda Organs have dunned into them a bunch of malarky about how "socialized medicine" is failing in Germany, France, and the UK, where the problems are mostly those created by budget cutting "conservatives"
Fixi the fee schedule for Medicaid can be done with legislative action. Doctors who only want to serve "priate" patient? Meet our enhanced IRS department charged with investigating Fraud and Self Dealing.
We could always draft every doctor (You have a Medical Licence? We can conscript you) for four weeks of service wherever the public need is greatest. The Indian Heath Service would be a good place to start.
investigation
Not just costs, but the enormous influenece of isurance companies which represent hundreds of thousands of jobs, directly and indirectly. And, then there is the staggeringly large amount of revenues and profits generated from premiums. Much of the money referred to as Wall Street money is actually from insurance investmentso f one kind or another,
She has repeatedly answered the COST question. The moderators continue to bait her into getting a tax byte to spam on the evening news. Let's be honest.
3
How can the insurance companies still be controlling us so much even after all these years? Its like they have a noose around our necks. It drives me crazy. How about we just stop subsidizing private insurance like crazy (i.e tax employer health benefits) and see how long they stay around for?
1
These folks who are afraid of universal health coverage are really just suckers for the insurance companies and their lobbyists who scream "communism" because they don't want to lose their cash cow.
1
Liz never saw a program she didn't like, but history proves one thing over and over again that the government is lousy at providing services. Ask yourself, do government bigwigs send their kids to public schools? Did you ever ask why? It's not because they don't support the public system, no it's just the opposite. They boost the public system all the time. They think it's great for YOUR child, but not right for them. Throwing money at a problem is not the answer, because in the end it's the family that educates the kid, not the school, and when you have an 80 percent out of wedlock student population, you have a permanent underclass that NO amount of tax dollars will rescue. So, spend 800 Billion or even a trillion dollars, the results are already known. You might feel better as a liberal, but accomplish nothing. With out a family these kids are doomed before their first day of preschool. Just ask the inner city teachers, they see it every day. Are we just too PC of a society to admit it to ourselves? So far the answer is YES.
No worries; Warren can do it.
Like you said, the problem with single payer is mainly political opposition fear mongering and disinformation.
We're gonna get there.
1
I wonder why she hasn't done the math already. Perhaps she has, and it doesn't look good.
2
When she presents her plan, I bet she'll see the wisdom of the Klobuchar route and offer a public option.
Elizabeth Warren’s reluctance to say “taxes for middle class people might go up” is due to her astute understanding of how primaries and the uglier general election play out. She might as well quit now if she dares utter that phrase. Of course, being the front runner, all the lagging candidates will beat on her, even though they have little to no chance of winning.
I can’t remember Ds or Rs, and very few journalists—I am not referring to you —asking trump any policy questions, being mollified by his sheer outrageousness, Mexico will pay for the wall, and I, alone can do this with my great big brain garbage. Unfortunately, the country will be paying that price for generations; so, I thoroughly understand why you’re asking, Paul.
I have always believed once she wins the primary, she’ll, of course, go more center. But I do believe she’s being totally honest in what she believes should be the foundation of keeping the health care industry from continuing to make $100 billion a year from people’s illnesses.
I, too, look forward to her upcoming plan and then hearing what you make of it. TY.
1
Krugman calls the Urban Institute, the source he uses to support his claim that our health care costs would increase with M4All, “left leaning”, but here’s a list of there funding sources from Wikipedia:
“Some of Urban's more than 100 private sponsors and funders include the Annie E. Casey Foundation, the Ford Foundation, the Robert Wood Johnson Foundation, the Henry J. Kaiser Family Foundation, the Charles Stewart Mott Foundation, and the Rockefeller Foundation.[9]”
Their website doesn’t even refer to them as “liberal”.
Krugman has assumed the role of point man for maintaining the much despised private insurers hands in our pockets - he’s the last person you should listen to on the subject.
1
Warren has pushed herself as THE wonk, capable of solving every major societal problem armed with hard facts and detailed numbers. She is now moving outside the comfort of her adoring non-critical base, and this facade is crumbling on many fronts. It has been a bad week not just on the medicare for all front, but for all her plans as her gurus Saez and Zucman are being savaged for their deceptions across the web (and it about time for the NY Times to follow up on that), and their dodgy math is all that support all her plans.
I applauded her initially for bringing some policy to the arena, but have lost all respect in the past year. Her hubris -- solving another major societal problem every Friday with a few pages of text funded by an inexhaustible supply of taxes on the rich, will do incalculable damage to decent policy as the emperor's lack of clothes are revealed.
It is truly insulting to the voters that after pushing Medicare for all for months, even co-sponsoring legislation, she has now suddenly decided to resolve the financing for almost 1/5 the economy with just a week of work.
Let me take a wild guess - Bezos will pay?
If we couple Medicare For All with Open Borders, we can soon look forward to everyone in the world needing a replacement kidney, heart, hip or shoulder replacement joining the queue.
3
Senator Warren is sure to bring some great analytics to the table but the human issue can't be taken off the table either.
I am a full Warren supporter so I am biased but I am doing my best to remain open to anything except know-nothing attacks, like the one from Sen Klobuchar. If there are some real figures that disprove anything, produce them, either pro or con, just give me the facts. I don't want another butcher job on a Dem leader just because ambitions are strong.
1
Medicare for all is a position that will ensure 4 more years of President Trump. Democrats will lose support of members of labor unions who have Cadillac medical plans. As a result Trump will win Michigan and Pennsylvania. Also Republicans will pound the Democratic nominee with the following argument:
We told you that the Democratic Obama Care plan was no good. Democrats admit that we were right. Now Democrats say they have a different plan, one that takes away your private health insurance and replaces it with a government run program. This new Democrat plan is worse than Obama Care. Vote for Trump!!
The Democrat's obligation is to save the country for this disaster of the Trump Presidency. For the love of God, don't blow this election!
Paul, you frequently and clearly post the necessary questions that our nation, Warren and any candidate must address to improve our nation’s health care system. Would you consider posting your solutions and/or would you post others’ solutions for the nation in future columns?
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Wouldn't it be great if there was an honest politician? Just one.
1
Krugman says ‘“Most people probably would end up better off under single-payer system ....”.
What is this based upon? It is amazing that he can make such a grand statement with nothing to back it up. It seems quite irresponsible to make such a claim with no evidence.
1
Well, the simplest solution for Democrats who are worried about all this is just to vote for Joe Biden, who supports building on the present Obamacare system by adding a public option.
There, what's so hard about that?
The short of it.
Krugman has no negative opinion on the economics.
He has the orthodox democrats opinions on the tactical electoral cost.
So what does he have to offer that all those dc poll geniuses haven’t already offered on tactics. The crowd that lost to Trump mind you.
Here is a strategic fact Krugman skirts around and Warren apparently can’t grasp.
SHE OFFERS POLICIES AS OF SHE WERE RUNNING FOR LEGISLATURE KING.
But the office she runs for is the chief executive office.
And the votes aren’t there no matter what anyway.
So she and her brain trust are burning the midnite oil to boldly run for that office in a way that increases the chance of Trump winning, all just so she can play act as legislature king. Don’t blame the Russians for this typical dc democrat self destruction.
It is insane. And all the candidates who say Trump is a danger are also doing all they can aside from being Senate republicans to make Trump the twice elected president. Fighting over what a legislature king would do. Democracy hating. Or they would never play this dumb game. Dungeons and dragons is more real.
Insane.
Warren made indeed have created a Medicare trap, but not nearly enough attention is being given to the very deliberate and fatal climate change trap that Trump is pushing upon the world, which his evangelical accomplices ecstatically regard as fulfillment of biblical prophesy.
Here is the relevant paragraph from the Urban Institute study Krigman references:
"This reform option covers the entire US population. National spending on health care would grow by about $720 billion in 2020. Federal government spending would increase by $2.8 trillion in 2020, or $34.0 trillion over 10 years."
1. They only give the overall cost of the plan for the first tear when there would be considerable startup costs,
2. When they give a 10 year estimate which would amortize the startup costs, they only give the increase in federal spending and ignore the huge saving in the elimination of premiums premiums both both employees and employers, THIS IS NOT THE BOTTOM LINE.
3 Finally the Urban Institute study itself is badly flawed. See
https://pnhp.org/news/the-urban-institutes-single-payer-cost-estimate-false-assumptions-false-conclusions/
The highest estimate of the 10 year costs I can find is from the Koch funded funded Mercatus Institute which is $32 TRILLION. The CBO has computer that we spent $3.65 Trillion on healthcare in 2018. So if we make the ridiculous assumption that costs will not increase in 10 Years, that comes to $36.5 TRILLION in 10 year. more than the cost of M4A. Medical inflation has been running at between 3.5% and 5%. Let's take the lower figure. Compounding the costs of our present system over 10 years that comes to $51.4 TRILLION. So M4A will save about $15 TRILLION over 10 years.
2
My wife and I till laugh at the one minute joke.
I suddenly lost my job at an engineering company in Florida in October 1986. My pay and benefits expired at midnight November 30, 1986.
The problem was company related- not my skill set. I had numerous requests for interviews, but since a buddy had moved to Dallas from my neighborhood in Florida, I agreed to be interviewed by a Dallas company. I quickly rec'd a job offer, but put off starting until December 1, 1986.
I was married with two small children. Not having medical benefits was a fate close to death. My benefits at the new company began 12:01 AM on December 1. No benefits for one minute!
Access to medical care is critical. I need not explain.
One of those two little kids is now a Resident in Psychiatry. When he began Med School about seven years ago, he learned from the very beginning that the greatest problem with healthcare in the USA, is insurance. He still believes it is true!
3
Krugman makes valid points and, gosh, his remedy for Warren is essentially what Kamala Harris has already proposed. The Senator from Massachusetts gets a bit more elbow room, apparently, than does the Senator from California.
03:00 H CET here in Sweden, and I have just read Krugman and a large sample of Reader Picks, where I am happy to discover the names I have been missing, the Verified Old Timers, with Karen Garcia at the top.
Why mention this?
Perhaps one way for us to get through to Elizabeth Warren on the subject of Universal Health would be for one of her staffers to follow recent advice from a Times Editor at the magazine who wrote in a Tweet: Go to the Magazine article on Thomas Chatterton Williams that appeared on line 10/17. The Editors advice on that article: Read the 150 comments, you will learn a lot.
Elizabeth Warren should have a staffer reading every column on Universal Health Care AKA M4A AND the comments.
That staffer would learn that every one of us European comment writers has carefully pointed out that in our Expat country private health care is available within the UHC framework.
I will simply repeat in brief form what I have written countless times, then back to sleep.
I have Medicare in USA and have to pay for Aetna Complementary Insurance to make that work. In Sweden I have SE UHC, which became TOTALLY FREE THE DAY I TURNED 86. But SE UHC is extraordinarily low cost to all.
So Elizabeth Warren and Paul Krugman, read the comments and learn and adapt.
Only-NeverInSweden.blogspot.com
Citizen US SE
A question from a long-time fan: Mr. Krugman, in a previous op-ed you said Warren was the "real deal". Do you still believe that?
I consider myself on the left but I can’t support anyone who is trying to take my private insurance away. I know many who feel that way