i am not a Trump supporter and i am an independent.
many problems are not considered very seriously.
first, is a wealth tax legal? even if legal how in the world could the IRS enforce same? how many audits could the IRS handle each year? How could they audit or determine the value of minority interests in vast asset holdings?
would the Senator's plan run unions out of business? after all, unions pushed corporations to provide health insurance for its workers years ago.
if the wealth tax is not legal or can not be collected in a reasonable amount of time, how does the government provide the benefits? do they default? what then?
So, Warren's fleshed out a plan here that's passed the Krugman seriousness test. You've panned Sanders in the past for taking Democrats into delusional economics as false as the Republican's, specifically over his Medicare for All. Yet, Warren simply picked up the imperative from Sanders, put in the expertise, and voila...gave us the recipe. Wasn't so hard after all. Of course, had Sanders been elected, it's very likely an equal level of expertise would have gone into it, as well as being tempered through the Congressional fires. But, it was as if you couldn't even consider it, because it was Sanders. You remain quite cool regarding the Sanders candidacy, and that's fine, because at least you have refrained from the irrational attacks of 2016. And you do seem reconciled to a rather more European model for American wealth/well-being distribution, sans the weird monetary quirks they have. Three years of Trump probably had something to do with that, I imagine.
Health care is obviously becoming unaffordable for individuals for employers, for state and federal governments and for the economy as a whole. As many analysts have demonstrated, Americans pay too much for mediocre results. Anyone who opposes Warren's plan should be pushed to answer the question of how they propose to limit our health care costs. Maybe there are other plans but I have not heard much from republicans or other democrats besides Sanders.
I would ask Senator Warren to think a little more about her "maintenance of effort" idea.
I administer an employer sponsored health care plan.
Her idea deserves merit because it calls attention to the fact that health care is already being paid for, much of from employer plan sponsors.
The problem with her plan is that the current system is inequitable for a number of reasons.
First there is wide disparities in how much employers pay, what they pay for and who they pay for.
State and local governments are more likely to offer generous benefit packages with minimal out of pocket costs and are far more likely to pay for both pre and post medicare health care.
Large profitable companies are also likewise more likely to over similarly generous benefits.
Meanwhile, smaller companies, more likely operating in a much more competitive industry and with lower wage workers are more likely to offer less generous benefits with higher out of pocket expenses.
And 40% or employers do not offer health care. They are frequently relying on employees who might get their benefits from a public plan or are dependents of employees with generous benefits. In other words, they are either genuinely at risk or they are freeloading of the current system.
A more equitable system might assess employers on a uniform basis, perhaps a percentage of payroll.
I administer an employer sponsored health care plan for 8,000 active and 4,000 retired employees.
I have spent a career with Taft-Hartley, multiemployer and collectively bargained health care plans. I see too many people forced to make a choice between paying health care premiums or paying rent. That is a system that is fundamentally flawed.
The emphasis is on "fundamentally". Our current system is built on the premise that health care is a privilege, a private good that some people either "earn" by virtue of their employment of they buy. Reform efforts too often focus on making it "affordable". Health care is not something that needs to be "affordable",. Instead, it needs to be afforded to us. That's why ideas like public options or Medicare buy-ins get us no where.
Health care is a public good, not a private good. The Public Health Service is one of the oldest federal agencies. Health care as a public good was almost a founding principle of this government.
There may be ways to get to medicare for all incrementally, but the public option is not one of them.
And why is putting Medicare up for sale any less radical an idea than Medicare for All?
If the principal themes of the 2020 election are immigration and demographic changes, none of this will matter. Trump will win the election, and those people who would benefit the most from policies such as was mentioned in the article will supply him with the votes.
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Professor Krugman, I'm disappointed in you. Up to now, you have been a lonely voice trying to make Democratic voters realize how unrealistic the Medicare for All plan, as Warren and Sanders both have proposed it, is. The savings projected are unrealistic per Catherine Rampell's column: read:https://www.washingtonpost.com/opinions/elizabeth-warren-tried-to-do-bernie-sanderss-homework-for-him-she-failed/2019/11/04/bddfb0b0-ff48-11e9-8bab-0fc209e065a8_story.html which, to be frank, is a hefty bit more convincing than yours. You sound as though you are trying to regain the favor of the progressives who turned against you because of your position vis-à-vis Bernie Sanders. Why? You are better than that. You don't need their approval. You just dropped a couple of pegs in my estimation of your economic journalism.
What's the basis for ever giving anyone left of center the benefit of the doubt on any subject that touches on any nation's economy? Has no one been awake (or to university) the last 150 years?! Honestly.
@Doug No, of course we should instead rely on the right-wingers in the current administration, who will have increased our annual budget deficits by hundreds of billions of dollars and our national debt by some 4.5 trillion dollars by the end of next year.
Just for perspective, are you Canadian or British?
I'm puzzled why Dr. Krugman is so positive about the Warren Medicare for All plan when he has been so consistently negative about the Sanders plan. Having studied both plans in detail, I fail to see any fundamental difference between them.
What is common to both plans however, is that neither Warren nor Sanders have yet committed themselves to allowing people to retain their existing insurance if they want to. Unless they do this, it's abundantly clear to me from the polls and from what I personally hear every day that, although the vast majority of ordinary people want Medicare for All, they will reject it if they can't have the assurance of keeping their existing health insurance if they want to. I'm sure very few would do so, once they see the personal benefits of Medicare for All in practice. But experience has taught people to be very suspicious of the claimed benefits of any change.
It seems only Buttigieg has fully appreciated the strength of feeling about this, and I think he could well win the primary because of it - though I'm quite sure he would never enact true Medicare for All himself.
In 2017 the US collectively spent $3.5 trillion on healthcare. Multiplying that number by 10 gives us an estimate that the total cost over 10 years is $35 trillion.
https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html
If Medicare for all does indeed cost $34 trillion over a decade (as an article in today's WAPO notes, citing the Urban Institute), we would spend $1 trillion less over 10 years with Medicare for all than we currently pay.
Democrats need to hammer this home again and again and again.
@TwoFeetThick Most people are, understandably, far more concerned about their personal medical expenses than about macro-economic crystal ball gazing of this kind. That's one reason that plans like those of Warren and Sanders won't be realized, and they won't be elected.
The biggest issue with Warren calculation is failure to account for very high healthcare costs inflation. She actually assumed that costs will go down. This never happened in the past - and it is not clear how this can be accomplished. If we knew how to stop healthcare inflation - we would have done it long time ago. ACA was also promised to slow down price increases - but the opposite happened. The plan is combination of day dreaming and wishful thinking. It is not going to work - also most working adults don't want to give up their current coverage and will probably vote against her in the election.
The reason all those other countries have universal coverage is simply that it makes the country run better. That used to be a core conservative value, but the new far-right conservatism is devoted to making sure the US government runs badly except for a few.
@Stevenz Dysfunction and ineptitude in our government were rampant long before the Trump era. Trying to start a huge new, unaffordable program that has widespread political opposition (and not just from right-wingers) would not make the country run better. It would be a disaster of possibly unmanageable proportions.
I like many of Elizabeth Warren's plans. And I think she has working people at the center of her focus. But I don't want the government to take away my private health insurance.
I am fortunate enough to be a member of a Union that provides decent health insurance. I wish all workers could unionize and negotiate for fair wages and adequate health care coverage. Medicare for All is a possible solution to the problem of those who are uninsured, but it is a nightmare for people who already have insurance.
If Elizabeth Warren becomes the Democratic nominee, and she doesn't figure out a way to allow people to keep their health insurance if they like it, then she will lose to Trump. It's that simple.
Most of my fellow Democrats are ready to support anybody who can defeat Trump. As of now I'm supporting Pete Buttigieg for president. His "Medicare for All who Want it" plan makes a lot more sense to me. And I think he could beat Trump.
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No one really agrees with her numbers, and the majority of voters do not want to be kicked off their insurance. So how does Krugman come to the conclusion that she passed the medicare test?!
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Another advantage to medicare for all is it could greatly improve capitalism-whistleblowers won’t be as afraid to blow the whistle if they don’t have to worry about losing coverage from their employers. Just a few percent increase in whistleblowers would have a synergistic effect, given the level of corruption fostered by Wall Street. Hey, apitalists, I don’t think you’re inherently bad- I’d like to reduce the pressures on you to be evil.This could save your trustfunded greatgrandkids lives-radical ommunism grows slowly at first in response to corrupt capitalism, but 80 years is enough time...
Warren should have tried something that Republicans would find believable - "The Canadians will pay for it."
Nice job moving the M4A goal posts for Warren, Krugman.
When M4A was put on the table by the Sanders movement, its disqualifying error was the "purity" of its demand to eliminate private insurance: it would not "play best in the general election," it was not "most likely to pass Congress if the Democrat wins."
[https://www.nytimes.com/2019/03/21/opinion/medicare-for-all-democrats.html]
Different criterion when it's Warren calling to eliminate private insurance, hm? Now it's, 'Are the #'s "serious"?
Sanders: 'boo purity test!' Warren: 'Meh, so it's "more aspirational than her other plans," even if (mild grumbling) I don't "enthusiastically endors[e]" it, even if a public option has "a better chance of actually becoming reality."'
"Prob' is, Warren's wonkery won't get her elected, but will more likely hurt her with the beer track electorate that will have to be galvanized for a Democrat to win. For that, you need an economic populist who can connect with people, who is trusted, and who has a movement ready to go into action behind him and beyond the election to advance M4A. Only one candidate fits that bill.
[https://thehill.com/hilltv/rising/462654-krystal-ball-democrats-on-track-to-nominate-warren-lose-to-trump]
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As Always Paul Krugman is fair minded & clear in his analysis.
He does't think Warrens plan will become a reality, but it is a comprehensive & potentially viable option.
Mr. Krugman has been a strong supporter of Obamacare, along with expanding and improving on it. At the same time he has been, at the very least, skeptical of Medicare for All. Former VP Biden's healthcare plan would strengthen Obamacare by doing pretty much what Mr. Krugman has been advocating for the last several years. Yet Mr. Krugman has been oddly mute regarding Biden's healthcare plan and has been devoting most of his attention (and effort) to either defending or rationalizing Elizabeth Warren's plan and her position on Medicare for All, which is as far as I recall, Mr. Krugman does not favor.
The only conclusion I can draw from this anamoly is that Mr. Krugman's fickleness on this issue is because he favors Warren over Biden as the Democratic nominee.
I recently spent two nights in the hospital mostly for observation. No surgery or anything complicated. The bill came to $46,000.00. A supply of blood thinner prescribed by the doctor was priced at $500.00. Left unchecked, the medical community will send us all to the poor house. The only institution that can do anything about it is the government and they mostly just skirt the issue. If we are all that rich and powerful, why do we not have universal health care like all the other advanced countries in the world?
Employees pay a significant and sometimes hefty portion of the premium for their Employer provided health care insurance . I wonder what will happen to that money? Sometimes it is well over 10% of what the employer claims to be paying the employee?
Does any proposal require the employee to be able to actually keep that part of their pay check? Or does the employer get to pocket that money that should belong to the employee?
I support Warren and Bernie's Medicare for All. It simply isn't reasonable for many people to have deductibles and co-pays that they can't afford. How many people are getting sick because they can't afford to go to a doctor and how many people have gone bankrupt because of high medical expenses? Millions have NO insurance.
Many people are needed for this Medicare to work. People who have insurance from other sources are needed to maximize the number of healthy and the ill.
I worked at the International School of Kuala Lumpur in Kuala Lumpur, Malaysia for 8 years and never paid ANY money towards my health insurance. I'd simply call for an appointment, go to the doctor and fill out a form. End of story.
I got sick and had to quit work. ISKL had insurance that paid me $36,000 a year until I reached age 65. I received a check each month for two and a half years. How many corporations in the US offer this benefit?
It is unconscionable that ALL people in the US can't get good coverage and be able to see their doctors when needed. Medicare for ALL!!!!
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@Carol Ring Your experience is very interesting, but not ALL Americans want to be forced into a government-run health insurance monopoly.
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The primary issue with Elizabeth Warren's healthcare plan isn't in the nuts and bolts. single payer/public option systems are well understood and all the details can be sorted out.
The primary issue with her healthcare plan is in the messaging. She is trying to sell this voters. She wants everyday people to look at her plan and agree with the details of her plan. But the reality is her plan is complicated. Most of us are never going to understand it all. I certainly won't.
Elizabeth Warren needs to be standing in front of business leaders and telling them that "my plan will limit the rate of increase on your corporate healthcare plans to the rate of inflation. You won't have to deal with annual increases between 5% and 10% anymore. Push for my plan and I'll deliver the tool you need to control the largest uncontrollable line item on your profit and loss statement".
Businesses in todays world are in a position where the cost to keep healthcare for their employees is rising faster than anyone can predict. It's certainly rising faster than businesses can grow revenues. Medicare for all solves that problem. It makes sure that the annual increases to healthcare costs are pegged to inflation rather than the balance sheet of a 3rd party middle man. And the people running these businesses are exactly the people who will understand the details of the plan. Thats who she needs to be talking to. Average people like me don't understand the first thing about healthcare.
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Let’s remember the insurance “hole” for two groups—those who retire before they are eligible for Medicare (average retirement age today is 59.8) and those who work full time but whose employers do not provide insurance. They pay high premiums and deductibles for Obamacare or go without. Too many go without. Why are we putting up with this situation? Why have we let our elected officials ignore this problem when they themselves have great insurance? We need someone with plan for that!
@JM Indeed, we do need a plan to address those problems. But not this one.
I will never understand why so many Americans think it is good that so many medical companies make big profits off of their ill health. The same hospitals and doctors will exist whether they get paid directly from a single payer or hundreds of insurance companies. I don't know what value insurance companies add to the system other than to provide money to shareholders and big pay for CEO's of these companies. I do wonder what the plan will be for re employing those who jobs go away when these insurance companies go away. Although, I assume non-profit companies like Kaiser Permanente will remain in business.
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@Sue Abrams A lot of people are happy with their private insurance, whether others understand why, or not. The insurance companies aren't going anywhere in the foreseeable future.
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The Warren/Sanders plan doesn't seek to expand Medicare to everyone. It sets up a whole new system that goes far beyond Medicare. In fact, it has benefits that go far beyond those of any other country in the world. Other universal coverage countries all pay about 80% of the patient's costs. The other 20% is paid by the patient, or more often, supplemental insurance policy paid for by the patient or employer. Traditional Medicare does substantially the same. It has a monthly premium, various co-pays, and excluded care. Warren/Sanders pays all of everything. It also makes any kind of private insurance illegal, which will make many Americans who are covered by employer or union plans reject it. It would never pass Congress anytime soon, and it gives the Republican propaganda machine a lot to work with during the campaign.
I think that the ACA with a public option and other improvements has the best chance of becoming law. The ACA becoming law took almost a miracle, so it won't be easy.
Pete Buttigieg's Medicare For All Who Want It is a much better plan. It creates what is essentially a public option for those who want to join it, allows those with private insurance to stay on it if they want, improves medicaid, increases premium subsidies and has move improvements. If the public option can provide better coverage at less cost, as people like me think it would, people would migrate to the public plan. And, it would have at least a chance of becoming law.
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I used to work for a Medicare Part B Intermediary; we adjudicated claims for doctor, lab and equipment claims.
I would like to see some actuarial analysis of Medicare for All and Single Payer, because the current Medicare Plans are not sustainable because they contain old people. And old people get sick and use medical services more than any other group.
In order to make them pay for themselves these plans must include younger people.
And finally, Medicare put these intermediary contracts up for bid and the primary decider was processing cost per claim. When I left it was under $2 per claim. We also had a line of business in private medical and those claim cost over $20 to process with all the exceptions.
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Bureaucrats and shareholders are the same, aren't they? It's just that shareholders take extra money out of the system for stupid things like gold toilets and status symbols. Wouldn't America be great if our status symbols were educated children and happy citizens?
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This is painfully disingenuous, this is the same person who bangs his chest about republican voodoo math yet credits Warren for nonsense math that doesn’t add up.
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Republican voodoo economics has been proven over and over again. we have never tried to modernize our medical insurance system, like most other industrial nation's have.
It's funny how things we think could never happen, or at least won't happen for a long time, suddenly do. Like gay marriage. Some things are just right, and ripe for change, and happen, and we look back and wonder how on earth we put up with the abuse and misery and ill health of our unaffordable healthcare system. How we let them sue us for medical debt, for Gods sake.
This could happen. And that's very exciting.
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“The inherent vice of capitalism is the unequal sharing of blessings. The inherent virtue of Socialism is the equal sharing of miseries.” —
Winston Churchill, House of Commons, 22 October 1945
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As the most inaccurate economist published today - you’re acceptance of Warren’s theories leaves me ...unimpressed.
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poor paulie. his candidate was beaten by a real estate salesman. and will do it again in 2020.
"Middle-class tax hike". What hooey. Last year, I paid $1800 as my portion of the premium for my employer-based insurance. I would GLADLY pay that much in additional tax for a system without $5000 deductibles along with out-of-pocket expenses and having to make sure a doctor is in my "network".
To those who are supposedly "afraid" to give up their current insurance: Wake up, dummies! Medicare 4 All would be BETTER than what you have now. SNL nailed it last night when it joked that the insurance companies are like a bad boyfriend. In the words of Dan Savage of "The Stranger", DTMFA!
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@leftwinger4 Thanks, but I'll decide for myself what is my best option without the self-righteous arrogance of so-called "progressives".
If the insurance companies are like a bad boyfriend, the government is like an abusive jailer. On good days.
Hello? Hello? Climate Crisis anyone? All the health care in the world will not cure that. It is the BIG ISSUE that all the candidates are daintily stepping around.
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"it would serve the public well if these topics — plus climate change! — got more attention in future debates, and health care a bit less.' tell that to w who have suffered serious medical issues - like virtually all human beings do eventually. are we incapble of adressing more than one subject at a timea?
If you really want to know the true cost of what Warne is proposing you only have to look to Europe. Basically it takes about a 50% minimum tax rate and up if you look and Europe and Denmark and the scandinavian countries in France it about €40000 your tax rate is 50% but this will not even cover the cost of Warren's plan. All these countries have found that they then need to add around a 25% vat tax. So this is what single payer health care really cost If you have American style private insurance that is for the 180 million of us our care and almost O all instances is superior to what you would get in Europe. This means no waiting for hip replacements bypass surgeries almost unlimited care for cancer Not happen in Europe. This is why you see so many Europeans fly into New York City persei to get their medical care when they have the funds because they are care is not state-of-the-art To get the basically 10% that's not still ensured we're going to dumb down our whole system bankrupt the country have massive tax increases and destroy economy all the men name of social Justice
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So you are under the impression that the ONLY difference between the European governmental programs and the US is the medical care, and that the ENTIRE difference in tax rates is due to that? Really? Otherwise their government costs exactly the same as ours, huh?
Warren doesn't seem to pass the integrity test though. Such machinations, just so she doesn't have to invoke a tax increase on the "middle class". This undefined and loaded term prevents desperately needed economic reforms from becoming politically accepted. We need courageous candidates (like Bernie and Tulsi) who won't run from political sand-traps.
THIS sand-trap needs some lighting. The political problem with the term "middle class" is because far more people associate themselves with it than actually ARE middle class. Those below the middle class often aspire to it and even consider themselves members, sometimes for the sake of dignity. Alternatively (and far problematic), there are MANY upper class Americans, especially the increasingly educated ones, who ALSO do not want to admit to themselves that they aren't in the middle class. These folks don't want the liberal stigma of being 'upper crust', yet still don't like the idea of being taxed as part of the "middle class". It ain't pretty.... And these the folks really should experience some tax increases.
The middle 1/3 of American household incomes, a reasonable description (or at least approximation) of "middle class" is $30,000 - $62,500. I suspect there are quite a few NYT readers here whose household incomes exceed this but have convinced themselves that they are middle class folk or mensch, like everyone else. They even like going after the billionaires - but talk of millionaires starts to make them nervous.
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When our government balances the budget which currently has a deficit of well over a trillion dollars, talk to me about government run Medicare for all.
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Warren and Bernie's plan is not Medicare for all. Medicare is the name of a specific government program, not some vague aspirational idea.
Medicare for all would mean extending the current Medicare program to everyone, perhaps with some modifications that don't change it's main characteristics. Medicare allows private insurance and it also requires payments from individuals. Berniecare or Warrencare do not. They are single payer plans that eliminate the other two payees to healthcare providers.
The concept and phrase Medicare For All has been around for years. But Bernie stole the brand name of the popular program to stick onto his unpopular and very different single payer plan, and now many people are confused about what Medicare for all would actually mean, allowing the right to demonize and conflate any program dems might advocate with the unpopular tradeoffs required by single payer.
And for those who argue that single payer is popular, well, why don't Bernie and Warren just call it that? In an election where we've been told that healthcare is the biggest issue, the candidate with a plan for everything has been hiding her healthcare plan for a year for a reason.
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Ms Warren ruled herself out of serious contention with her plan. if she were serious she would propose Medicaid for all, not Medicare. Making the federal government pay for shortfalls suffered by States. The difference in costs would have made her plan viable. Instead she declared war on nearly everyone. Or she could have guaranteed Medicaid for all uninsured, and set up a government insurance plan to cover high deductibles for those on Obamacare and those on employer sponsored healthcare. She effectively shifted her initial appeal to Biden or even Buttigieg.
I live in Canada. Our universal health care is just ok. It is good with cancer,stroke, and heart issues. Not so much with the rest of it. Long waiting periods and fewer specialists. Incredible inefficiencies. Waiting 6 to 10 hours in an emergency room for treatment of a broken bone is no fun. At the same time, you won't lose your house due to medical costs. Best look to the European systems that get better results at a lower cost by blending public and private health insurance.
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Same, but since they have the possibility of doing it from the ground up, they can emulate the NHS. The NHS is great.
What if her plan doesn’t cost 20 trillion, but rather the 30 to 40 trillion that most experts (along with Joe Biden and Bernie Sanders) say it would?
Do 40% go without Medicare for all, or do we start taxinf the 45% of American workers not paying any income tax, or do we add a further burden to the tax paying Middle Class?
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When I worked for an accounting firm, I learned that partners were expected to make the maximin individual campaign contribution to the GOP. I suspect that major corporations may have the same requirement. So Trump should expect a bonanza from corporations and executives to prevent a Democrat, especially Warren from winning the presidency. Corporations will be doing all that is legal and maybe not so legal to keep their Trump tax cut. The same for businesses which benefit from the qualified business 20% tax deduction.
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I’m new in the Medicare system, but there a though that I don’t get it. I used to work for a company, which did not have more than 18,000 employee. We paid for a complete (medical, dental, prescriptions, hospital, etc.) plan $71 dollar for single people. Medicare cost me $135/monthly . How my company could could get such a deal for some 18,000 person and Medicare could not for, say 10 million, that is $1.3 billion per month, get a cheaper and better plan. Where the money does goes?
Because the cost of insuring a risk pool of all people over age 65 is higher than the cost of insuring a risk pool of single working people. You were working, so you were probably not sick, but still paying every month. If you got really sick, your company which you came to count on so much for health insurance that you were afraid to change jobs, would have fired you. Then you would have no insurance. You were lucky to make it to Medicare age. You can't loose your health care now.
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Warren delivers a plan, an actual, not fake plan like Trump promised but did not even try to deliver. That counts for a lot.
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you talk about medicare for all in an abhorrently abstract way, as if it won't have a tangible impact on people currently struggling to survive due to inhumane medical debt.
if warren's plan is 'aspirational', it is not a plan at all. bernie is the only candidate with a plan that will help those worst affected by the US' unjust private healthcare mess.
i can't understand why you dismiss health and climate change as topics that shouldn't be discussed, when they are the most critical issues facing humanity right now.
as always, the NYT cares more about farcical 'electability' and corporate agendas than real political change. i'm disappointed.
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@everyone's different
Cheaper actually to pay for private health insurance for everyone.
@everyone's different We've already seen the result of folks focused on narrow agendas considering "electability" farcical, thank you very much. If a far-left extremist like Sanders or Warren is the Democratic candidate in 2020, we'll find out again how very wrong they are exactly one year from today.
I'm terribly concerned with this idea and there's no way that Elizabeth Warren can backpedal her way out of it. Remember what the Republicans did to vilify a true war hero who *volunteered* to go to war in Vietnam in 2004? How about Willie Horton in 1988? Those same Republicans are chomping at the bit to inaugurate the catch phrase, "Warren is taking away your healthcare."
It doesn't matter that her plan may be better or has a solid basis behind it. Republicans have proven that it doesn't take much to turn people against a Democratic candidate for president. All it takes is one small notion that the Republicans can amplify into victory. [See: Emails, et.al.]
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Joe Biden thinks Warren is making it up:
"She's making it up. Look, nobody thinks it's $20 trillion. It's between $30 and 40 trillion dollars. Every major independent study that's gone out there— that's taken a look at this, there's no way—even Bernie, who talks about the need to raise middle class taxes—he can't even meet the cost of it."
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A detailed plan is good for showing you are thinking seriously about the issue but it also presents a juicy target to attack. And tiy can bet the house that Republicans will work overtime to create non-existent holes and try to convince voters that those details are sure to create a cataclysm. A counterattack asking them to come up with alternate detailed plan will be brushed off claiming they don't have to, the present system is good enough. which happens to be true for most Americans who are either on Medicare or employer provided insurance. The minority that is seriously burdened by the present system is not large enough to win an election.
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Making the center piece of your platform a subject that has befuddled, and stymied Presidents from FDR to Clinton to Obama, at a time when the country is over run by division, and kleptocracy, is a bridge too far. Just win the election, then deal with health care. Figuring out how to pay for it, even if all assumptions are 100% correct, is just the beginning. As much as we need reform, we need a return to sanity and honesty first. Dream big, but keep your feet on the ground.
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You win elections by proposing policies that will improve people's lives. That is what she is doing
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@Randy That only works if the proposals are believable. Aside from which, many people do NOT believe her ideas will improve their lives.
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You when election by proposing policies that actually stand a chance of being enacted, and that appeal to centrist voters.
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Mortgage the country into oblivion with this plan. Depression results. 2 million lost jobs. All tax revenues spent on health care, No room for any error. Budget blows up. Unemployment skyrockets but everyone gets an antibiotic and a bandaid.
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And your evidence for this? Do you think that we're not going to pay many trillions for health care over the next decade under the current system?
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@Randy
I do...but let’s fix this the correct way. Allow everyone over 55 yrs to go voluntarily on Medicare and give Medicaid access coverage to those who are on ACA who meet economic levels up to mid middle class. Small out of pocket required so people think twice about abusing the ER, etc.
This should preserve the good things about our system and provide good coverage.
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Wife and I retired, both covered by Medicare. But, also have a UHC Supplemental Insurance Plan. No coverage for hearing aids, vision/glasses, no dental coverage. Co-pays required. Premiums to Medicare and for the Supplement. Watch pharmacuetical ads on TV that seem to be unending and perpetual. Much better that Pharma take that ad money and reduce drug costs. Slicing management bonuses and salaries should take place, but probably will not. Watch streams of pharmaceutical sales staff showing up at my doctors office -- gotta be a better way. Leave the system alone, expand Medicaid coverage, set drug prices to stop gouging. Work toward increased doctor count and expand nursing ranks. We are an aging population and provider demand is going to continue to expand. Bottom line, look at the total picture. Believe hospital and doctors office support staff costs have room for greater efficiencies. Technology coming to the fore in that area. Need to speed it up.
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" In particular, it’s nothing like the snake oil that passes for policy analysis on the right, whether it’s the continual insistence that tax cuts pay for themselves or Paul Ryan budgets that assumed that discretionary spending could be cut to Calvin Coolidge levels." Thank you, Mr. Krugman, this is probably the best line I have ever read in a newspaper. So funny, yet so true ...
6
My question to Warren is: Do you want to be right, or do you want to win? What are your plans for getting Medicare for All into law?
Americans lucky enough to have private insurance tend to like their insurance. The privat health insurance industry would fight this tooth and nail. You can’t win my state, Virginia on Medicare for all—Nor North Carolina, Wisconsin, Michigan, Pennsylvania or any other centrist states. Hello! Earth to Elizabeth! You’re kissing the White House good bye with this program.
3
You don't start a negotiation with your compromise position. Yes, it is unlikely that M4A happens. But starting from that, you compromise to something like a public option. If you start from the compromise position, you end up with something worse. When you buy a car, do you begin by offering sticker price and negotiate from there?
@Randy Warren won't have to worry about where to start negotiating because she isn't going to be elected.
1
So under Warren's universal Medicare those who get healthcare through employer insurance would not have that money back as higher wages or salary and then have to pay higher taxes to compensate for Medicare. Instead the employer will pay that into Medicare and have their wages/salary not change?But either way Medicare For All as described by Warren seems like a very good deal.
2
A wonderful idea, brilliantly planned out and a huge election loser.
People are afraid of change. People don't want to be 'forced' to do anything.
Tens of millions of people are not ready to give up their current insurance for some plan that may, or may not, get enacted and properly funded.
And what happens when Republicans get back in and start cutting the funding, or even the whole program?
Please Ms. Warren, you are a good candidate but a good leader knows that they can only push their people so far.
The majority of people would support being able to opt in to Medicare. If Medicare is better the majority will eventually migrate without being 'forced to' and their private insurance being 'taken away'.
PS
As someone who has lived overseas I am constantly amazed by Americans who design their Health plans without really looking at other countries. Many other countries (Australia, Switzerland) have a combination of public health supplemented by voluntary private insurance for elective surgeries. There is no need for Health Insurance to be a binary choice between Public or Private.
4
If Canada is such an earthly paradise of medical care, why do cancer patients with means in Toronto drive regularly for treatment to thriving private clinics in Buffalo, set up expressly to serve them?
(Answer: They get their treatment in a timely manner).
9
Everyone with cancer drives to the US for treatment? Irrational fear mongering not based in reality.
2
Uh, because they don't. This is a persistent and thoroughly debunked right wing myth.
1
Not a myth. I lived in a universal health care country (UK) and the only universal thing about the medical care there was that you didn’t receive it and the waits were so long even for routine things that you had to pay to see a private doctor anyway. It was way more expensive than the US.
America pays more because we have more money. Others are subsidized by American investment, like with free trade with poor nations, NATO, UN, etc.
Once you kill the goose, all will suffer.
As an economist, I'm surprised Krugman prefers government monopolies, pretending that central planning is better than free markets.
1
Familiarity undermines insight. People can apparently get used to just about anything. If it's reasonable to tie health insurance (and consequently health care) to employment, how about other basic needs such as food and shelter? Perhaps employees should become wards of the corporations that employ them.
Making health care universally and unconditionally accessible would have profound effects on the decisions of prospective employees. Employers might have to pay better wages and provide improved working conditions to keep employees on the job. No one would have to suffer an unrewarding job because of great insurance.
Uncoupling healthcare and employment would change much more than the mechanics of insurance. Eventually, we would all be much better off.
4
Yes, save money by eliminating “the sheer number of people doctors and hospitals have to employ to deal with multiple insurers”. And what do Warren, Sanders, Krugman propose that these eliminated workers do for income? Crickets.
Retraining? Retraining for what? Trade adjustment assistance in the 80’s and 90’s for displaced manufacturing workers only served to extend unemployment benefits. Folks were trained for low end computer jobs which, in short time, also disappeared.
I know, Republican talking point. But still, got a plan for that?
2
So you want to keep a dysfunctional system as a make work program. Sounds socialist to me.
1
I'm glad that Krugman found that Warren was being realistic from an economic perspective, though I wish I knew (maybe her plan says?) what will happen to the people who now have jobs in the existing health care industry who will lose them. But I'm still concerned about what I'll call the psychological perspective. People get scared at the thought of losing their doctors or losing their ability to choose among doctors if they have a serious medical condition. I'd be more comfortable with a "Medicare for all who want it" with a more gradual transition, per Buttigeig's suggestion.
1
Tying IRS enforcement to her healthcare overhaul is not smart, it's sneaky.
We should be rigorously enforcing our tax law to catch illegal evasion already. Tax evasion is already COMING OUT OF OTHER AMERCANS' POCKETS via higher taxes paid, higher federal debt servicing, and reduced services. This is not "found money" waiting for a new government program, it is money that should be used to reduce the tax burden on the majority of Americans who don't cheat.
Sure, I'll place the majority of the blame for lack of IRS funds at the Republicans' feet, but the currently uncollected taxes should not be thought of as a piggy bank for a new program.
1
It's not just that no reporter asks Republicans how they plan to pay for a tax cut. I understand that tax expenditures feel less like "spending" than actual spending, though they are.
But the $70B increase - just the one year increase - in the Pentagon budget is about $500 from each American household, there being about 130 million of them. $500. Per Household. Per year. For just the INCREASE.
Nobody in journalism ever seems to do that simple division, or ask a single politician the question "How are you going to pay for that increase to the Pentagon? Will you be billing $500 to each household, or will you be billing those who make over $70,000 per year twice that much, or will you just borrow all the money? When will we pay it back? After America is totally a peace? If so, when do you expect that? How much interest will the $70B each year rack up before peace on Earth comes?"
Badgering? Only about as much as Warren was. Then things would be proportionate.
Oh, and The Atlantic put "free college" at $40B/year back in 2014. Even if $50B/year now, you could take it by reversing some of the Pentagon increase. So Warren can just say that.
4
What is it with Americans that even lefties are playing the idea that you should not raise taxes on the middle class? Aren’t you supposed to pay for the government services you get in return? I agree that the first to pay (big) are the tax evading billionaires and corporations, but even then the middle class cannot expect to get more for less. Strange ideology, in which we should lower the taxes in every election cycle while every one can see the effects of that when evading the potholes in the road or when dying because one has no health insurance.
1
A heart attack is Serious too. But I would t want one and I don’t want Warren’s plan. And I am willing to bet that the majority of Americans won’t want is either.
2
Why can't Warren just say the same thing about her health care program which Republicans always say about tax cuts....."It will pay for itself!"
Unlike the Republican tax claims, in the case of Warren's plan, it will be true!
4
A question for Paul Krugman, the author. If part of an employee's compensation is Retiree Healthcare, which is a benefit that is accrued over several decades of service in both the Private and Public Sector, and extends past 65 as a supplement to Medicare, isn't E Warren proposing that the Federal Government strip hundreds of thousands retired employees of a earned benefit so she can reallocate those "earned benefits" to non employees? And if so. if this is done, aren't the harmed retirees entitled to balancing compensation since they would have been compensated differently if they had not been accruing retiree benefits over decades, and probably would have been paid more as a result of accrued greater pension and 401K benefits ? Isn't she proposing a theft of earned employee retiree benefits?
3
it's a good plan. most people will vote for her . the electoral college is still up for grabs but she will get the nomination and let the people decide. if they want trump it's won't be because of her health care plan.it seems to me it'll be because of race, gender, sticking it to "elites," along with a decent economy , no new wars involving Americans and no terror at home.
Let me explain how our universal health care system works here in Canada, so as to dispel any misunderstanding many Americans have.
Our taxes are somewhat higher than our US neighbours. But, remember, I pay no premiums for my government health insurance. If one considers premiums paid to health insurance companies in the US as a tax but to a private company, then surely our American neighbours pay higher taxes than we do.
My Ontario Health Insurance Plan (OHIP) covers all physicians and hospital bills; there are no co-pays and as I said, no premiums. But, OHIP doesn't cover everything. Dentistry, drugs for people aged 26 - 65, chiropractics, optometry for those under 65, physiotherapy, etc (I can go on and on; there are many services NOT covered by OHIP). These services are covered by private health insurance in Canada.
I'm not saying the US should adopt our system. But, instituting universal health care does not mean there is no role for private insurance.
I urge our American neighbours to learn how other countries have managed to solve how to provide health insurance as a human right.
7
I’m glad to see that Warren put out a thoughtful blueprint to providing and paying for single-payer. I’ll look forward to her implementation plan to be announced in the coming weeks.
However I do agree with Krugmans assessment that single-payer is the least important of Warren’s various plans. Her plans to redistribute wealth and power back to average Americans, reduce government corruption, and combat climate change are all more important, urgent, and impactful.
I like single payer healthcare, but first I want my country back.
6
It should have strong support even from seniors if there is no premium. Most seniors pay at least $200/month for Medicare + Medigap coverage + Part D coverage. Granted, that is still a tremendous bargain, but it is still $200 that many seniors without pensions can't really afford.
1
I will agree that Warren's plan is serious and thoughtful, but it is far from well-presented. It is very difficult to follow numerical data when it is not presented as a chart. Challenging though it would have been to create an accurate table, it would make understanding her analysis that much easier. She does identify many areas of expense and how these would be pared, and her assessment of sources of revenue seems to be comprehensive.
She does not however explain what would happen to private insurers as corporations, in terms of their employees, their insured, their proprietary data, and shareholder equity. Does it vanish? Does she pay off investors? The value of private insurance as a business model becomes zero under her plan. The top 10 insurance companies have a combined value of $275B. Something like 3 million employees. Does she absorb these companies into the Centers for Medicare and Medicaid? That analysis is missing.
Moreover, she blithely states that all physicians will now be reimbursed at Medicare rates, which for many practitioners would amount to a 50% or greater reduction in net income. She also doesn't take into account that adding several million insured with present resources of physicians/providers/hospitals would create a severe excess of demand.
So, I appreciate that it's thoughtful, but I think that underlying this is a certain hubris that she is right. And apparently inflexible. Not appealing; not to me.
2
Even Trump admitted that no one knows how much our medical system actually costs. The actual savings and costs are currently unknowable. This is one way insurance and medical industries have inculcated themselves from change.
This is why I'm leaning toward Warren. Her record of holding financial industry accountable is the skill we need in health care. She has the backbone and intelligence to bring the need changes. I'm convinced and I'm voting Warren.
4
We could just start with banning political contributions from drug and medical device maker companies and seriously negotiating lower costs of these products, which would go a long way toward reducing health care costs for everyone - Medicare or not. (Has anyone looked at the actual cost to the hospital for a new heart valve, pacemaker implant or hip joint?) Lots of 90+ year olds get these. One also might consider bringing back the "death panel" concept of a few years ago, where physicians would get paid for counseling sessions with their elderly patients regarding end of life decision making. Lots of patients who probably would not make that decision on their own end up for weeks on a ventilator with no realistic hope of recovery because family members cannot make the decision to end care. As for the younger population: Make healthy food affordable. High tax on cigarettes and soft drinks.
2
Her 'four main components' seem to miss two main "elephants".
One, concerns the INCREDIBLE expense of American health care, which Bernie Sanders addressed in the last debate. Targeting the health insurance industry is relatively easy (and fairly superficial). Targeting our monumental health care and pharmaceutical industries is the real ballgame. And this will not be easy when so many Americans depend, emotionally, on their doctors. Warren doesn't even go there because she wants to get elected, above all else, imo. Bernie Sanders calls it like he sees it and the American people reward him for this. The corporate establishment, on the other hand, does not.
The second elephant in the room is of course the potential availability of vast wealth from military budgets. Again, this is something that Elizabeth Warren seems afraid to address. On the other hand, Tulsi Gabbard is going right at it. And with her military experience and her politics, Tulsi Gabbard is one of the few who could actually crack this. Both candidates represent rare opportunities for major progressive reform in America... and Dr. Krugman and his paper will be fighting them all the way.
2
Doesn't really answer the central question of unit cost in total on everything that constitutes healthcare vs how much would be spent under Medicare-for-all (or any other plan). If it's less, which is generally good, most persons could be winners (except, possibly, some healthcare service and product providers). If it's more, which is generally bad, it's more of a question of who the losers are going to be.
2
Medicare gets taken by non-profit, highly profitable hospital/clinic businesses. The 10 minute in & out visit (extended to 20 + by shifting waiting time from lobby to private room where an assistant briefly pops in) is charged to Medicare as an extra-long (45 min.) visit. Granted the doctor does spend time to view and type computer records, and some type during the brief office visit instead of looking at the patient.
Still, the highly profitable non-profits and other medical entities might double bill for the same visit, too. Once the same billing for the same visit was mailed to Medicare with slightly different wording on separate days. Medicare paid twice. As non-profits, accepting Medicare patients is not exactly charity. For example, the automatic blood test using the corporation's own machines is charged out at more than ten times what Medicare allows. Plus there's a separate item billed for taking the blood sample and moving it to the lab, which Medicare doesn't pay for, but that is considered a loss. The 90% for the blood test that Medicare doesn't pay is posted as a loss to maintain the corporation's no-tax status. With fewer choices of medical care because of consolidation, fewer options to find medical corporations that fairly bill Medicare. Will "non-profit" profit-driven medical businesses shift their billing practices from corporation insurance + Medicare to Medicare only? Should they remain non-profit?
The same country that exploits its citizens for health care industry profits, does the same with guns.
We need articles in US media about the many US victims of shootings who are uninsured, and then devastated by high medical bills for hospital treatment.
We let high profit gun maker lobbyists set the norms for our gun safety laws while they finance politicians' campaigns.
Then in a truly surreal response, our politicians say any laws to ensure affordable health care and restrict guns for all everywhere are interfering with our 'American Freedoms'.
Compare this to other capitalist democracies in the world.
They that have sensible strong gun laws, and health care for all. In both, profits are not the priority---citizen health and lives are more important.
What a difference this makes to the safety and security in their lives, that Americans are deprived of---in what is called the world's 'greatest democracy'. What's normal abroad is deemed radical here.
What could be more newsworthy?
Where is the publicity on this in American media?
Where is it in NY Times columns?
2
This option is totally unrealistic on many fronts.
Unlike other countries with single-payer systems, US doctors have much higher incomes. How likely is it that Warren will be able to pass a plan that includes pay cuts to doctors? She is expecting doctors to accept reimbursements at the current level Medicare level. Expect to see doctors leave the profession if that happens.
Retirees and I am one, pay for Medicare Part B and can opt for private insurance as a supplement. We know the cost and we know the quality of care we are getting. Why would we choose anything less?
Elizabeth Warren is not making any friends by vilifying the wealthy and the big corporations. The wealthy and the big corporations have been bashed for years and it doesn't accomplish much besides to antagonize them. Her criticism sounds old and tired.
Why not expand the Affordable Care Act? Include a public option?
Most taxpayers favor expanding access to affordable health care. But those of us who already have it don't want to end up with less.
Many voters fear anything that looks like a socialist plan and this one does. As an ultra progressive, Elizabeth Warren won't attract voters across the aisle.
I can't imagine another four years of the Donald.
8
@S Kaller
How many Americans working in the health care industry realize they will be getting a pay cut?
People misguidedly think the only “change” will be to insurers.
3
@AACNY Yes, that is a good point. Everyone - nurses , orderlies, technicians- everyone gets a pay cut. Many more honest economists have said many hospitals, the less profitable ones, may rural ones, will close. Of course, leftists don’t care about the people that will be affected by this. Those nuisances in flyover country.
We should not listen to Elizabeth Warren! Medicare for all, free tuition, forgiving student loan debt, the Green New Deal, reparations for blacks, and infusing all government programs with affirmative action are political positions that cannot be achieved. If the Senator is serious she should have a plan for putting social security and medicare as they currently exist on a firm financial footing. The programs should be expanded first to meet the needs of current recipients, e.g. dental and hearing aid coverage for Medicare recipients and reforming social security so that widow provisions for women who work can't be gamed at the expense of men as they are now. Medicare taxes do not reflect the costs of the covered individuals. There is no cap on the income that is taxed yet all people get the same benefits. Taxes should reflect insurance costs and not be a subsidy for lower income recipients. The system also should prohibit the subsidy of lower performing groups with the use of affirmative action in selecting employees who administer the system. Once the systems for social security and medicare are based on fair and efficient employment and administrate rules we will know the real costs and be able to decide if either of the programs can be expanded in fair and cost effective manner.
5
The thing I think Krugman is ignoring is democrats as well as the republicans in congress are owned by the insurance and health industry and will never pass this, much less the Supreme Court who can use whatever justification they want to declare it unconstitutional.
3
Another consideration I never hear, but we talk of it on our US Senate campaign in MT, is that of opportunity cost. Not a given, but possible, if the ACA battle is any analog, that MFA means zero progress on other critical fronts such as climate, Education, tax reform, infrastructure and job creation. www.muesformontana.com
1
It's curious just how little detail Dr. Krugman gets into here. He's certainly capable of dissecting the details here, but chooses not to. I wonder why.
Take for example Warren's proposed 6% wealth tax. Combined with her plans to increase capital gains and apply that tax to unrealized gains, this would mean that large fortunes subject to the tax would, in aggregate, decline. Fortunes simply cannot grow with that set of taxes, but must shrink. So that source of funding is not sustainable even if you ignore potential negative secondary effects.
Easy math on that one, but Dr. Krugman is silent.
(Of course, inflation factors into the analysis, but if you assume higher inflation so that larger fortunes persist in nominal terms, then you also need to increase the cost side.)
3
The test of the cost of a single-payer system is not as simple as how much people will pay in taxes for it. Right now, the people pay for every dollar of their health care out of their pockets one way or another. If you have employer-provided insurance, HR first determines what it would cost to put a person in your seat. If they calculate it would be $100k and their "share" of your health program & simply deduct it before even quoting you a salary & then offer you $90k. You've already paid $10k as far as the corporate labor budget is concerned. Then you have annual deductions, monthly withholding, co-pays, out-of-network costs, uncovered procedures, uncovered meds (or constantly rising co-pays), 80/20 reimbursement on many items, annual & lifetime dollar limits. Then you have to figure in how much we taxpayers pay for ER visits & other treatment for uninsured or under-insured patients. In the end, Americans pay upwards of 19% of GDP per capita for coverage that doesn't cover everybody & doesn't cover everything for anybody. In France, where I lived for a time, all you do is pay income tax - about 10% per capita - and everybody is covered cradle to grave. It is a phony argument to imply that single-payer taxes would be in addition to what we already pay. Most countries cost half per person what we cost & get far, far better comprehensive coverage for everybody.
3
I just want a Democrat in the White House. Medicare for all sounds nice, but under the Trump administration more Americans are losing their insurance right now after the steady gains under President Obama.
We need to strengthen ACA now!
4
I am a 74 year old retiree here in the USA, who worked 37 years as an expat engineer building and operating major oil and gas projects around the world. Over my life, I have spent time in clinics and hospitals in the USA, Germany, Saudi Arabia, the UK, Kazakhstan, Finland. All the European medical staff and facilities were every bit as good as those in the USA. All of those systems are supported as universal healthcare systems. Those universal healthcare systems, at $3800 to $4800 per capita per year, or half the cost of the divisive American for maximum profit system. Pharmaceutics in all other countries are a fraction of what Americans pay. But here in the States, the pharmas and insurance and HMO lobbyists pay a lot of money to the politicians, to keep them at max profit. Sad.
282
@Joe Miksis I lived in Germany as recently as 2014. Germany has a variety of companies selling health insurance, not a single payer system. My employer and I together paid over $15,000 per year for my health insurance. The amount you pay depends on your income. Poor people pay nothing for health insurance while receiving the same medical services as everyone else. There is nothing universal about the -support- for it, since only people with income pay for it. I agree with you that the healthcare industrial complex is completely out of control in the U.S. We could probably pass laws to end or at least rein in lobbyists. But only if we could convince Congress to stop stuffing their pockets with lobbyist cash. Creating a new enormous Federal agency to centralize more power in Washington does not seem to offer much of a solution.
12
I agree with this post but something about the comparison with Europe, Canada and all the single-payer systems keeps nagging at me. Most, by far, of the new, pivotal, breakthrough drugs and procedures - biomedical innovations - are developed in the US under our deeply flawed system. It does a lot wrong for plain-old universal care at rational prices, but the system continues to create incentives for pharmaceuticals and medical procedures that are developed here (or by and for US investors) and the fruits of those efforts are then distributed around the world. Yes profit is bad - but not if the risk of failure, and cost of entry, are high. So if the US goes all egalitarian and reins in costs and puts the lid on Big Pharma, is an unintended consequence a slowdown in biomedical innovations?
13
@Joe Miksis
Is there a Memorial Sloan Kettering equivalent there?
1
I get frustrated with the "fix everything all at once" mentality that exposes the objective to failure because of the unknowables. If getting everyone covered is the core objective, start with the highest risk. For example, start with automatically covering all children under 18, all college enrolled, and all in a public service organization (e.g. Peace Corps). Then see the effect. Add more as the data and facts support the plan.
Trying to fix a 100 year old problem all at once with estimates and forecasts is a plan; just a bad one. I do not advocate going slowly, just not hastily.
The need here is ACCESS to quality healthcare and portability. That can be done in several ways that won't cause the administrative boondoggle Senator Warren's plan would cause in its conversion not to mention a flood of wasted money in the process . She should listen to Mayor Pete and Joe Biden. We can augment the existing ACA and provide access to those who need and want it without shocking the entire national healthcare system. Another goal should be to remove healthcare from employers and dissolve the "group requirement" from insurers. Let employers increase wages with the money spent on employee insurances and let the employees own and administer their own health insurance (just as they do every other type of insurance) This would keep portability if the employee wishes to make a life change. We may also want to keep the cost of medical insurance as a tax credit on its own line to increase affordability.
On a side note to the Democratic candidates: Watch the "Free Stuff" talk..it is not timely or convincing even to a progressive like me. Nothing is ever really free and people must have some investment in their choices to make it meaningful and fair.
1
I'll be blunt here: Senator Warren needs to adopt Paul Krugman's preferred public option approach as the best beginning toward eventual affordable universal health care. Otherwise she'll fail to initiate or achieve any significant reform if elected.
She also, I believe, risks torpedoing her chances for becoming president. The radical change, complexity, and the financial unknowables of her proposal will largely be a no-sale to the American public and corporate America. It will also provide abundant ammunition to the health care industry and all the conservative voices still insisting that a better competitive market is the fix to our health care mess. Her candidacy, I fear, will die along with her proposal.
Let "Medicare as an Option for All" be the principal starting point for reform. Then trust that a Medicare system will progressively out-compete commercial insurance for cost and coverage. Market forces will then eventually restrict for profit insurance companies into offering supplemental plans only. Polling data shows that majorities of both Democratic and Republican voters support this approach. On a graduated income basis above the poverty line, taxes will increase on us all. But our overall health care costs per family will significantly decrease. We need to trust that most Americans can do the math - and support a politician accordingly.
Don't let one version of unachievable perfection indefinitely postpone starting to travel down the road to significant reform.
2
This "plan" is in the stratosphere, and not serious.
Now it would be serious if a source of funding was to raise taxes.
Really are we to b-e-l-I-e-v-e -- the wealthy will not find away to pay steep WEALTH taxes.
And you leave out, Warren even proposes we will net a $400 Billion gain, if we open the boarders and make all illegals US citizens.
That's fantasy Mr. Krugman, not a "pass".
2
One thought about making employers pay into the public fund. Employers that were more generous would end up paying a lot more than less generous employers. But their employees wouldn't directly benefit. It is like requiring people to pay into Social Security what had been paying into their private retirement savings account. The bigger savers would end up paying more. Or requiring people pay into the public schools what they would have paid for a private school without letting them use the private school. I don't favor diversion from public to private, either, such as paying fewer Medicare taxes to pay for private insurance or diverting Social Security taxes into private retirement savings accounts. Nor do I favor Vouchers for private schools. No diversion in either direction is what I am for.
2
I am so glad that Elizabeth Warren has come out with her plan. Now Warren and Sanders (who the NYTimes seems to ignore) have to show Mayor Pete why his incremental approach is not going to work. There will be no administrative savings with the incremental approach. Employers will still have to maintain human resource staff to decode the complex insurance products and hospitals will also have to maintain billing departments and software to deal with the insured, under and uninsured. It may actually be worse with the public option since the insurers will cherry pick patients and leave the sickest for the public option. I am not an expert on health care financing but anyone who has been seriously sick or has a loved one with a serious illness can see that a structural change is necessary.
3
What is the impact of all the jobs lost in the insurance industry and in doctors’ offices, pharmacies and other related insurance support across the country?
1
@JSullivan
Maybe jobs can be created that do not depend on turning human health into a profitable commodity.
3
Senator Warren has fleshed out a plan that guarantees Trump's reelection unless of course it prevents her nomination.
Personally I'm for Senator Amy with Mayor Pete for VP.
5
I agree that the American Healthcare system is a disaster, Warren’s is workable and it won’t possibly happen in the foreseeable future even if the Democrats take over everything. The main problem is Americans can’t think out of our box. We live in the greatest, richest country in history so everything we do do is the greatest. Americans refuse to change; to adopt the metric system, allow socialist programs to take care of those who can’t manage on their own, have higher education for all, or guaranteed health care. Maybe Americans can’t do simple math. Add up all the sundry costs we all pay for health care every year and think about not having that expense. Maybe Sesame Street can start a segment on healthcare for everyone and in about 30 years...
2
Basic Econ 101 - Economies of Scale.
The same system that allows Walmart, IKEA & Amazon to deliver so much stuff so efficiently to the masses.
Better health care tot he masses than more stuff...
1
It's a long term goal, but makes sense for lowering all over costs which are insane ($1200. ambulance ride of 8 miles to an ER after a car accident), unaffordable drug prices, etc. We need to return to the "we're all in this together", to ensure others, and repair roads. We are more than a group of individuals, rather members of a society.
4
Good idea. Bad timing
Just win the election.
69
@Don Detrich
Medicare for all who want it
would lead to a win, as will those who choose it winding up better off than those who don't.
In five years, that will result in Medicare administrating the nation's health care system for 2% instead of the private insurance sectors' 18% and up.
9
@Don Detrich
First it is an idea whose numbers don't really add up and second it can't pass even if she does win.
@James the numbers are up just fine as confirmed by people far more experienced than you. If you feel they don’t, show us your math. You’ll find you’re absolutely missing the “single payer” part of this equation and what that does to pricing and thus affordability.
2
I believe we need to move to single payer healthcare, or “Medicare for all who want it” but need an a transition period. What are Warren’s plans for the hundreds of thousands of people who work for the insurance companies?
A key point both Warren and Sanders make is that there can be workable ways to get to universal health care coverage for Americans. And both are willing to point out the huge cost Americans pay the "middle man" - i.e. insurance companies - simply for the sake of being a "middle man" - but a component in which many millions of dollars are continually siphoned off in terms of corporate profits, and not being used to actually provide health care. Whether the political will is there to have the type of fight that will ensue (given the lunacy of the far right over the ACA) is a separate issue; having national leaders who are willing to say "we can do better and get more for our money" is vital to moving the discussion forward. The far right snake oil salesmen who are funded by the insurance companies want the undereducated public to believe that the lose actual health care just because the service delivery model is changed from insurance company profit driven model to direct government pay model. And do so with scare tactics "socialism!" being shouted by those with their hands in the cookie jar.
3
This whole topic worries me - a lot.
The job of Democratic candidates is to get Donald Trump out of office before he completely destroys all our institutions and Constitutional form of government. Hitching the wagon to Medicare For All, which is controversial and not broadly popular, gives him a weapon to use in his campaign. And it will be fought tooth and nail by the powerful and deep-pocketed insurance and pharmaceutical industries.
Remember also that the savings from “eliminating bureaucracy” means eliminating hundreds of thousands to millions of middle-class jobs, with no plan for mitigation. That is going to have some negative economic effects and create an additional segment of voters among whom it will be tremendously unpopular.
Warren and all of the Democrats should run on strengthening and properly funding the Affordable Care Act, which was quite effective at driving down the number of uninsured (before Republicans took power and sabotaged it) and IS broadly popular.
We all agree that universal health care, which the entire rest of the developed world has, is ultimately necessary in a modern society. But it is not realistic to think we’re going to jump directly there in a deeply divided country and political system. Losing this election over it would be a disaster for our country.
2
Elizabeth Warren has the same problem promoting Medicare for All as Vegan's do convincing people that a plant based diets is healthier, reduces suffering, and is better for the planet.
People know this, they just don't care.
1
After watching politicians on the national scene make promises for decades and then seeing those promises shredded when they come up against opposition politicians (and this is definitely something that "both sides" do with predictable frequency), I no longer get upset about what presidential candidates promise. What I don't like are vague, off the cuff statements ("I'm going to build a wall and Mexico's going to pay for it") that have zero basis in reality. Warren's team came up with a plan. At least they have a plan. We all know that it will not be implemented as it currently stands. As it passes through the legislative branch, it will be altered. The right wing will drag it as far to the right as they possibly can. But at least she's got something to work with, unlike the other side, which has been in office for three years and has yet to lift a finger to help us with overwhelming healthcare costs.
6
Since they need not return profits to shareholders, government sponsored GROUP plans should be significantly cheaper than private plans. In competition with private insurers, government sponsored health insurance soon would dominate the industry based purely on market forces. As a "capitalist to the bone," Warren should find this approach an attractive means to make the transition to Medicare For All. I hope to find something very similar when she releases her transition plan later this month.
My biggest concern is that Medicare for all, which as Krugman notes is not politically feasible, will be an easy target for Trump.
Substantively, I am surprised that Krugman, as an economist, does not at least consider how a single payor system will impact decisions currently subject to competition, e.g., the compensation of doctors and other providers, including current differences in compensation among specialities. Another term for a single payor system is a monopsony. Is there any concern that the single payor — the government — will, through its reimbursement decisions, misallocate healthcare resources? The cost issue has received much attention but other possible unintended consequences have not.
Before we commit to throwing out the hard won ACA the proposal for a single payor system should be the subject of a rigorous study. In the meantime, public support for an improved ACA, including a public option, should be acted upon.
3
@Fourteen14 You’ll worry about them when they retire or leave the profession.
I'm a liberal Democrat who favors single payer in principle and a big fan of Krugman, but he's way too generous to Warren here. This is not a serious plan. It has obvious fatal flaws: it punishes large companies that currently offer good insurance and small companies that currently offer any insurance. It creates a massive incentive for large companies to spin off employees into private contractors of small companies. Also, a 6% annual wealth tax? I'm all for raising taxes on the rich but at a certain point it feels like you're just making up unrealistic numbers.
Being more serious than Paul Ryan is way too low of a bar. The big issue here is that Warren is promising voters the sun, the moon, and the stars without having a realistic way to pass it and, frankly, even a lot of Democrats aren't sure that we SHOULD pass a lot it. I'd much rather have a nominee who pares down their plans to a few realistic, popular plans with plausible means of financing.
17
@Edward Swing
So, another Dem who wants a candidate to aim low. That will get you exactly what you are in favor of, single payer in principle today, tomorrow, next year, next decade.....but somehow never in fact.
23:30 EDT, 11/01
4
@mancuroc Most of the rest of the developed world does fine without single payer. It is not a requirement for universal coverage, which is more realistic than Medicare For All. There’s a lot of real estate between aiming low and MFA-or-bust.
2
When you further analyze this plan, it offers something many Americans have lived without for a long time - freedom!
Freedom to seek employment and change jobs as needed. Freedom to start small businesses. Freedom from insurance company rule-making that changes drastically from carrier to carrier. Freedom from crushing surprise billings or collections or judgments for medical debt. Freedom from begging for basic care, or freedom from witnessing the grotesque inequities of the current system that makes people forgo needed care even when insured due to deductibles and co-pays. Freedom to have an equal place at the economic table even if you have a chronic disease or disability.
In a time when climate chaos may make frequent job shifts highly desirable, taking healthcare out of the equation is critical.
We need to do health underwriting as a nation, open up our research and findings, and help all Americans reach the goal of affordable healthcare as a basic human right, no matter our wealth or status.
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@Barbara I don't see why a public option wouldn't provide the same freedom without the disruption. It would provide a choice and a timeline for the public option to demonstrate whether it could provide superior insurance service.
7
@Barbara Thank you for these comments, you make excellent point particularly regarding the climate issue which I hadn't even thought of. I run a nanny service and have lost nannies as a result of the fact most clients don't want to contribute towards healthcare for their nannies, understandable given the costs. I work hard on getting a decent hourly rate but it isn't enough. I also have a disabled daughter who is on our insurance right now but will lose that when she turns 26 and of course has pre-existing condition so all this is very personal to our family.We have good cover now but pay an enormous amount in co-pays.
8
I strongly disagree. Americans have more freedom than others. Freedom often does mean insecurity, but that is what drives Americans forward, to excel beyond all others. Security will turn us into just another country. Want security in America? Hustle for it, earn it.
4
I am all in favour of universal coverage, and a public option. But single-payer is a trap for Democrats that will lead to electoral ruin. Most people with private medical insurance, even progressives, don't want to give it up, and will oppose this proposal.
Warren and Sanders seem fixated on the Canadian single-payer model, ignoring that some of the best medical systems in the world, including Germany, Switzerland, and Israel, include a mix of public and private elements and deliver excellent health care at an acceptable cost. Why not learn from them?
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@Grouch Who, who are these people? I have never ever heard anyone ever say that they like their private for profit insurance. Do they love paying huge deductibles and copay's and being denied coverage. This is a tired old industry talking point that has zero merit.
47
@MDM the same people who obliterated the democrats in 1994 because of hillarycare and again in 2010 because of obamacare.
9
@MDM But people generally prefer the devil they know to the one they don't.
10
I've been puzzled, for years, that millions of Americans, who have insurance of every kind, do not understand how any of it works, much less understand why it is so expensive. (Clue: it has something to do with profit and stockholders.)
2
I love you Paul, but the fact that Warren's proposal will not pass in its current form is evidence that she is not serious about anything signaling to her base. A serious effort to address the issue would involve the admission that she doesn't know what the solution would look like but that she intends to lead a pluralistic and pragmatic effort work on something achievable.
2
It will never cease to bewilder me that Democrats need to publish plans, enumerated to the nth degree, for all of societal ills; however, Republicans, with no plans for anything other than enriching the already rich, can sit back and shoot down Democratic plans with their same old dismissive attacks, while not offering anything but promises to repeal and replace with some unknown, unfunded and uncontemplated phantom plan that will never come to light. This country should reward those with the intelligence and foresight to feel the need to produce plans and penalize those who feel the voting electorate doesn't require the time it takes to be a credible candidate for this nation's highest office.
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@David Warren for President: The person with the plan that works for everyone.......
3
@Fourteen14
Though I find some Democratic strategies, or lack thereof, questionable, it certainly is not intelligence Republicans are exercising to their advantage - it's survival instincts.
1
@David
Republicans have propaganda arm in fox and right wing media, and evangelicals congregations where ideological issues dominate. No need for realistic and specific plans. Other than guns, abortion and hatred to liberalism, all is based on faith.
15
You can build all the gated communities you want, easily communicable diseases can all get past the gates. Death and disease doesn't care who you are, or how much money you have.
From a "business" perspective, a society that countenances the needless suffering and death from disease squanders it's most valuable resource: humanity.
Greed appeals to the archaic feudal mind that lives behind its castle walls.
My income is around 60K a year and I spend 650 a month on health insurance. In addition I have out of pocket expenses on much of my health care because I have a 6000 deductible. DO the math. I would be happy with a 2% tax for health care, its a lot less than I am paying now.
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@LAURA F.
"My income is around 60K a year and I spend 650 a month on health insurance. In addition I have out of pocket expenses on much of my health care because I have a 6000 deductible."
That is absolutely INSANE.
If you have any savings, you'd almost be better punting your insurance and paying cash for whatever you really need.
Am I right?
4
@LAURA F.
I commend you for doing the math and being able to articulate how much you have to spend before you ever see a medical professional that your insurance pays for. Between premiums and deductibles your total outlay is $13,800 per year or 23% of your gross income. I am pretty sure that rate is higher than your federal income tax rate.
I wish more of our fellow citizens would add up their annual costs for premiums and deductibles before rejecting M4A proposals. I think many people would find the tax increase would be less than the current cost of their employer sponsored care.
Since many employers have an open enrollment period during Oct/Nov/Dec, it is a great time for people with employer sponsored healthcare to calculate their minimum cash outlay for 2020. The data is right there in the plan description! The formula is monthly premium x 12 plus deductible. To find out what percentage of your gross income you pay out for healthcare, divide that number by your annual salary.
My outlay for a high deductible plan with a health savings account that covers me alone will be $7500. A family on the same plan would have a minimum outlay of $18,700.
People cannot rationally evaluate M4A until they know what they currently spend on employer sponsored health insurance. The candidates would be well advised to assist people with making those calculations.
Hopefully, Senator Warren has a plan for helping people calculate their costs!
20
@Bryan And therein lies the dirty little secret. You have to do gamble-math at the beginning of open enrollment and say, "Hmmm...premiums plus a deductible for my family will be $14k-$15k this year. What type of horrifying accident would I Have to get in to make that worth having?"
Most of us pay out those insane premiums and because we are lucky enough to be healthy, never reach our deductibles. Meaning the health insurance ends up paying for absolutely nothing. What a waste.
14
Too much debate over healthcare in this country is centered on how to pay for the end product without actually dissecting for critical review the actual practices of medical care which drive the high costs in the first place. I have direct experience and much lingering consternation about the inefficiencies inherent in our current medical care system which too often result in far greater costs to the financial side of the industry than is warranted or necessary.
At the outset of a non-emergent patient work up, complaints often are categorized & slotted too quickly, before an ideally efficient diagnostic treatment plan has been precisely revealed. Our medical care industry (MCI) does not reward those investing time & talent into refining understanding of where a work-up needs to move so that inessential side tracks are not taken too early in the process just to ensure that ‘we are not missing anything’. As a result, resources are wasted before it is even known that the system is looking in the right place for a diagnosis.
One solution to this critical failure of our MCI can be to develop a branch of medicine, call it ‘concierge’ medicine. This new service should be made up of highly experienced MD’s nearing or just entering retirement. After emergency cases have been diverted into the high intensity evaluation & treatment they require, remaining cases should be funneled through concierge care for cost-efficient evaluation that cannot now happen under the current system.
2
Why are we constantly worrying about how to pay for a national health plan when we are the richest nation on Earth? If President Roosevelt can implement Social Security in the midst of a national depression, if Britain devastated by WWII can implement National Health System right after the war ended, why can't we do when we are rich and able? Do we need to be downtrodden to implement this?
272
@Jaque Big Medicine doesn't want a national health care plan and are fighting it as I write. They, along with Big Pharma want to continue to blood let Americans over and over again. They are not interested in providing affordable health care, they cherish the gold they now receive.
12
@sheila
Great comment. So thoughtful.
6
@Jacquie Please be clear what you are talking about when you are referring to "big medicine". I can assure you that the overworked/understaffed people working at most hospitals are not part of the cost problem--the problem is "big private for-profit insurance" and, if you are going to include the hospitals themselves, "big administration"--not the boots on the ground people who are delivering the actual medical care.
5
Funny how democrats have to account for every penny that will needed for a future plan while Republicans just talk about how expensive everything is and then spend spend spend. Let's talk about the budget deficits under this administration verses the previous one. I'm glad Democrats are held to account but this shouldn't be so one-sided.
278
@Karen there is no secret here, spending is easy and laying out an actual plan is incredibly hard. We have very few in the GOP who are capable of laying out a spending plan (on anything) that doesn't result in their loss in the next election.
10
@Karen - That's not the only double standard with a higher bar for Democrats. Compare the level of bad behavior that led to Al Franken and Katie Hill resigning, with the words and actions of the current President. After having cheated on at least two of his three wives and being accused of sexual harassment by NINETEEN women, he continues to enjoy the support of evangelical Christians, because, you know, "G_d works in mysterious ways."
1
@Karen So true!
Unfortunately, the Republican-Trump party has morphed into the least educated in history. Facts/#'s clearly do not matter to them.
4
"...Warren needed to show that she was working the problem. And she did." And there, right there, is the essence of Elizabeth Warren. Paul is correct when he writes that Medicare for All is most likely not to become a reality in the very near future. It will take time, of course, and probably not become a reality in my Baby Boomer generation. However, with Warren we can be assured that she will maneuver that long and winding road to affordable and accessible health care for all somehow and someway. She is a quick learner and can read the politics as well as the needs of our citizens. She is shrewd, but in a good way, a way that will help the everyday American in her/his daily challenges. Most importantly, her goal is targeted toward the unequal distribution of wealth. It is unjust, unethical, and amoral. Period. And it must stop now.
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@Kathy Lollock
Two Percenter made a comment a few entries above yours, the essence of which was that he didn't like her because she sounded like some college professors he had had. His comment bothered me but yours has helped me formulate a response. You wrote, 'She is shrewd, but in a good way....' Many academics and experts are pompous (I'm a professor, by the way) and strikingly blind about the limits of their expertise, with egos that do not let them see their blind spots. Yet we need experts, especially ones with solid judgment and good hearts. The latter qualities help them deal with their limitations. Elizabeth Warren is one of those rare individuals with these qualities. Shrewd, but in a good way.
21
@Kathy Lollock All of us are not going to support "equal distribution of wealth." Unequal outcomes are a powerful motivator. It's important that that motivation is motivation for a better car or a swimming pool rather than something to eat. And it's mandatory that that unequal wealth not buy greater legal protections and political clout like it does now. And it's very important that that unequal wealth be re-earned constantly against a constantly challenging system of social mobility. But total equality of outcome would be bad.
3
@Robert David South Neither Elizabeth Warren nor Kathy Lollock (in her comment above) supports “equal distribution of wealth.”
5
I believe that when it comes to it, Elizabeth Warren is practical. I've wondered how she could speak in such grand terms and still actually get things done versus being shot down as too head-in-the-clouds. This proposal helps answer that. Not by presenting something that will get done, but by presenting something people can debate, amend, and compare their solutions to. This is a useful bridge to her excellent articulation of the problems she's trying to solve.
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Before anyone on the right can begin to criticize Warren's health care plan, they need to ask themselves: where's Trump's? Why hasn't he produced a cohesive and comprehensive plan in the almost three years he's been in office? Why do we require detailed analysis from the left but let the GOP skate by with their promises of a "great," "tremendous," and "affordable" plan?
722
That’s a fair point. People are calling Warren’s plan aspirational, but Trump’s is fantasy. It doesn’t have numbers or even contours, it’s just “better.”
Commenters point to how it signals her values. Trump’s signals that he recognizes it’s important to voters. The big difference is Warren’s is serious.
In Trump’s best defense, he criticized the GOP plan for being harsh. But he supported it because “better” healthcare wasn’t a promise he was willing to sacrifice for. He wasn’t serious.
When you add to that the GOP legal challenge to the ACA that would erase protections for pre-existing conditions, coupled with denials that GOP reform would erase those protections, it’s inescapable. Their plan is a scam. It’s a return to worse healthcare wrapped in broken promises.
But if you look at the GOP position, it has been basically consistent; “there is no healthcare problem (other than the ACA).” The “death panels,” “you can’t keep your plan,” “costs will go up,” and “Romneycare is unconstitutional,” arguments oppose all efforts at health reform. So there’s no reason for them to impose the same rigor on their plan.
If this were a rational process, however, we would analyze a “no action” alternative (the current ACA), a GOP option (just repeal the ACA), a public option (from Biden et al), and Medicare for All (Sanders or Warren). The GOP could cite pre-ACA statistics, but they won’t. They’re not flattering.
Trump’s promise was a fig leaf; “better” is not a priority.
40
@Gabriel H - You forgot "beautiful!".
20
Or for that matter Trump’s tax returns.
8
Mexico will pay for it!
(it worked for Trump, it might be worth trying it?)
1
Dear Mr Krugman,
Why endorse "Medicare of All" then write but "won't happen"?
What ever happened to "American-can-do".
Have you become another weak-knee, gutless member of the lost American's?
This is USA—grow a back bone and help create the NEW GREAT USA!
3
No, Paul. Her "plan" fails on every level,,,,but you know that. How are you different than the blind Trump supporters when you advocate for this?
2
I think the bar can’t be set any lower. “You’re not gonna use fractions after you leave high school, so show me you’ve heard about it.” is what he’s saying. From a professor to another professor. He set himself up to torpedo the Warren campaign, and he didn’t want to be that so he goes “I think she did it.” then outsources the number checking, when his whole life was bashing others by his wonky numbers and figures. Then he brings in Paul Ryan. What a travesty of a writing.
Make America Healthy Again
1
My senator.
It's a good day in American when Krugman and Warren are on the same page.
Bernie introduced his Medicare-for-All bill in 2017 and many Democrats came out in support of it, including Warren, Cory Booker, Al Franken, Gillibrand and Kamala Harris, who was actually a co-author of the bill. For some reason, Warren took all the heat from the media on how it would be paid. Not Bernie, but Warren.
Her options were to 1) pivot to the center like Buttigieg who was for Medicare-for-All at the start of his campaign and now is vocally against it, 2) ignore the media and constant attacks, or 3) dive deep into the issue and come up with a plan.
Warren chose the latter and that is a testament to her character. She is fearless. And smart. She is not defined by triangulation. She is different than what we are used to and can motivate an entire movement with her aspirational style. She has that "special quality" exceptional leaders have.
Now that she has answered the media's question, a question that should have been leveled at the author's of "the damn bill," can we move on and talk about climate change and student debt and immigration reform for a change?
1
@Ed Buttigieg is not against Medicare for All. He says that we need a way to get there.
One that is not so terribly disruptive that the GOP will capitalize upon it. Just like in 2010: remember "Death Panels"?
And cause us to lose the House in 2022. Just like what happened then.
Buttigieg's plan, if enacted, can get passed by Congress. Then, once enacted, more and more Americans are likely to opt into it with each passing year.
1
the senate demurs.
WARREN’S MAGICAL MEDICARE FOR ALL PLAN
Analysis: spending proposal relies on unmerited optimism
https://freebeacon.com/politics/warrens-magical-medicare-for-all-plan/
Voodoo economics at best. Time to give back that nobel prize in economics and go back to HS math and economics.
Talk about pie in the sky
2
I think we just shoved them up north.
50 miles. Get out of our way.
She has snatched defeat from the jaws of victory. How long can RBG hang on?
1
Sen. Elizabeth Warren (D-MA) said her agenda to provide amnesty to all 11 to 22 million illegal aliens living in the United States and driving up legal immigration levels will help pay for her “Medicare for All” plan.
2
Shocking that Krugman is giving a big thumbs up to Warren's fantasy assumptions.
1
Warren's inclusion of the mark-to-market taxation of capital gains (on the top 1%, not all of us) is a $2 trillion revenue source and a good idea advanced, in a different form, by Sen. Wyden, ranking Democrat on the Senate Finance committee.
Fun fact: Bernie estimated Jeff Bezos made $60 billion last year. That would be unrealized, and hence untaxed, gain on his Amazon stock. Mark-to-market captures that as income.
By contrast, Bezos's salary is roughly $1 million, so he is not exactly worried about a 70% income tax rate.
More on this, please.
https://www.cnbc.com/2019/09/12/sen-ron-wyden-raise-capital-gains-tax-to-fund-social-security.html
1
@Tom Maguire You do realize hat stock prices fluctuate? An that when all these wealthy people sell large amounts of their stock to pay heir tax, the stock market will nosedive, takin your IRA with it?
"Am I enthusiastically endorsing this plan? No. I still think that a public-option-type plan, which lets people buy into Medicare, would have a better chance of actually becoming reality..."
Paul, have you ever published in your column any cost analysis to show that your plan would be better?
Do you know the history of Medicare and its costs? Here's one view:
https://reason.com/2011/12/13/medicare-whac-a-mole/
Submitted 11/2/19 @ 9:41 a.m. EDT
For most US people, Heath Care for All is socialism, and socialism, Evil.
2
I think Turkey would start WWIII if necessary.
Well, what do you want in a President? Is this AnybodybutTrump vs Anybodybut a Woman? Warren is not burdened with any of the baggage of so many sorts HRC schleps around. Bright, charismatic, energetic, honest, no friend of Wall Street. What's not to like if you want someone to do the work rather than play golf?
1
@Bob Marshall “ Honest”? Don’t make me laugh.
And Fox News blared headlines - $52 Trillion. Can I sue the fake news outlets?
1
Ah, every other major country can afford Medicare For All. The US can't? Boo-Hoo.
1
Thank you, Paul Krugman.
1
Mr. Krguman yes, you know economics.
But you sure don't know politics -- or the dynamics of mass public opinion that determines political outcomes
It ever there was a number in politics guaranteed to drive mass pubic opinion negatively it is $20 trillion.
No matter the math, no matter the economics, no matter the decent intent of a policy proposal, much of which sounds far-fetched to ordinary non-economist folk, that number is one assured to be ridiculed and feared with the grave risk its author would be also.
And we cannot afford that loss.
1
This article avoids the biggest issue with Medicare for anyone, much less Medicare for all. Our expenditures on health care are radically skewed to the last year of life. The reason is that with Medicare, there’s no disincentive to getting a few more radiation treatments for abed-ridden yet elderly beloved family member whose life expectancy with a reasonable quality of life has already been exceeded. Hard choices like there do not have to be confronted are avoided by physicians, spouses and children when the cost is passed on to Medicare.
2
This is communism! The fastest way to bankrupt American economy. Krugman: you do not know what you are supporting! So dangerous...
3
Why, oh why, in a world that desperately needs the electoral defeat of Trump, do we Democrats have our leading candidates proposing unrealistic, ain’t ever going to happen, policies like Medicare for all?
Come on Krugman, you know you are grasping at straws with this ridiculous defense of Warren.
2
Imagine our current "president" developing a plan, well for anything. All he would do is make vague promises about how "very very beautiful" it will be and how it would be the "best plan ever in history"! Then he'd sit on his hands and crow about everything else and after some time had past he'd admit that it was WAY more complicated then he ever thought, that ANYONE in history ever thought! Eventually, with his first term "rounding the bend" he'd start to promise that during his NEXT term he'd definitely develop THE plan and it WILL be "very very extra beautiful"... BUT only IF the American public gives him ANOTHER chance to do SOMETHING right and good...
You see, I don't have to imagine this happening, because it ALREADY did. The "stable genius" we ALL know is obviously incapable of reasoned thought and thoughtful planning at any level.
1
She committed political suicide by doubling down on this plan and reiterating that all private insurance would be abolished. It's so stupid. Instead of "giant pharma and corporations" running health care she wants huge, huge, mega huge government to run it. That kind of system will result in incompetence, inefficiency, corruption just like most government owned entities. The American spirit, or what is left of it, is so antithetical to this sort of program it's amazing she's going for it. She is either amazingly naive or has some blind, lustful revenge against "big corporations," and thinks that "big governments" are perfect angels. A vast system like that will not resemble Medicare, it will resemble the Medicaid I was on when I was fighting cancer and had no income. Crowded waiting rooms, inferior equipment, overworked doctors and never free.
2
No worries about paying for this plan as Senator Warren will never become president. She is the USS McGovern II and will ensure four more years of destruction by Trump should the Democrats be so foolish as to nominate her. And for the record, I am a Democrat.
1
If you eliminate private insurance (i.e. insurance companies), how would costs not go down? I wish I knew how much of every dollar spent on medical care went to insurance companies. Seems to me if you eliminate that middle man, you save bigly.
@Michael McDaniel
80/20 Rule.
The 80/20 Rule generally requires insurance companies to spend at least 80% of the money they take in from premiums on health care costs and quality improvement activities. The other 20% can go to administrative, overhead, and marketing costs. The 80/20 rule is sometimes known as Medical Loss Ratio, or MLR.
Savings would be in the neighborhood of 10% based on the ACA mandate that 80% of every premium dollar go to actual providers... as you would still have administrative and overhead costs under Medicare For All.
And while there might be some efficiencies, leading to savings, the number of uninsured is close to 30 million and millions more have inadequate coverage so we would still have to pay for these individuals.
1
Running for political office requires a mix of vision and nuts-n-bolts. Whether Medicare-for-All happens is really not up for debate, it will. The question here is how will it be implemented. The short answer is that it will replace private health insurance and the trillions of dollars spent to pay for that insurance. Overall costs will plummet and care will improve. Hospitals will be confined to one set of rates rather than the hodgepodge gouging that goes on today. Doctors will make less overall but they will pay far less in malpractice insurance and work less.
Americans are really bad at math. Right now, we spend about $3.5T per year on Healthcare. That is 18% of everything our economy produces. If we spent at the same rate as the next Most expensive system, Switzerland at 13%, we would spend $1T less per year.
So, what do we get for our expensive system. Overall, mediocre results.
What we cannot afford is what we have. And our system cannot perpetuate itself. So, either you engineer change, or just wait for it to blow up.
1
Those over 65 already have medicare-for-all. Why is it so outrageous to imagine that the rest of us can have it too? It already exists for a huge percentage of our population, and that group will be getting larger and larger as baby boomers age.
Many comments on here, and even Krugman's pessimistic tone ("just won't happen"), suggest this is something brand new. It's not. I think the "haves" just like knowing there are "have nots"--in some perverse way it makes them feel better about themselves. We are such a stupid country.
The problem with these large scale systems is that they have so many moving parts that to accurately predict their benefits and costs is a fools errand.
The only way to know is to try it for 6 to 8 years and see of something works.
The problem with America is that we have lost the shear guts to try something and see if it works. If it does not then try something else.
Heaven forbid if one party or the other actually came up with a solution. Neither party can have that.
But the VSP's in the media will continue to trash it, and people will believe the trashing. So this is likely DOA.
Professor Krugman who has been wrong on everything about the economy since Trump was elected, now says that Senator Warren‘s plan passes the test. The $52 trillion plan! With assumptions that are ridiculous on their face. Just one, that if we legalize the 13,000,000 illegals in the country they will step up to the plate and start paying taxes.Last time I checked, dogs do not have wings.
1
The Medicare system is not obligated to, and does not, give six-, seven- and eight-figure bonuses to the C-suite occupants of its fancy, ultra-modern offices, for the simple reason that there are no C-Suites and the chief officer of Medicare makes just a shade over $250,000/year, salary and bonus combined. Medicare's shareholders, i.e. every one of us, receive our dividends in the form of lower, much lower costs.
That the outlay for the delivery of medical services will be less per visit/procedure under Medicare is a no-brainer, and will be even more so when Medicare is allowed to bargain directly with drug and device makers. Doctors may not make as much under Medicare for all, but most will still make as much or more than the chief officer of Medicare. Most of the doctors can only wish and dream of making what insurance and pharmaceutical and device CEOs, CFOs and COOs haul in, many or most of whom would be insulted to find their bonus check is only a paltry quarter-of-a-$mil.
And as for billionaires, Bernie is right: If you can't eke by on $999,999,999, you are a very sick person.
Repeal and Replace is just as ridiculous coming from a Progressive as it was when it was chanted by Conservatives.
1
Did you all collectively forget that Medicaire is a big reason for inflated drug prices in the US? Another big fat bloated inefficient government institution that needs to be removed NOT revered.
1
That $20.5 trillion outlay is going to scare many, many people. It sounds absurd, laughable, and it is cringeworthy -- unless and until you look at the big picture.
Will Americans do that? I doubt it. We want the facts to be fast, few, and simple.
"If you can't explain it to a six-year-old, you don't understand it yourself."
~ Albert Einstein
That's what we're up against. Sure, Dr. K and the readers of the NYTimes understand it, but will it play in Peoria?
Not unless Liz and her staff can come up with something like "10 Reasons Why M4All Will Save You Money."
KISS works in advertising and politics.
Remember, the selling starts when the customer says no. Few things sell themselves.
Almost is bound to advertisers.
How about if a person advertizes this:
Bomb a foreign country. Get many thousands of dollars back.
It's a great return! You only die 1 of 100 times.
Wonderful. Call now. It is a limited time offer.
Go with a public option and drop Medicare for All, which is a political loser.
A for effort
F for content.
What Warren seems to forget is that after you split up the tech companies, break up the banks, destroy health care, an eliminate insurance companies, and tank the stock market -- you will have no one left to tax. This plan works in year one but that's it. Soon we are Cuba or Venezula -- where everyone is equally poor. Warren's arrogance is exceeded only by her ignorance.
Trump in 2020!!!
3
Well, maybe she (or Bernie) won't be able to get the "Cadillac" of MFA, and will have to settle for a "Chevy" plan of the Public Option, but who'd a thunk that even a Public Option was a possibility 3 years ago?
But the Public Option isn't without it's shortcomings either, and I think Liz and Bernie need to do a better job of showing why the full blown MFA is really better than the P.O. As it is, with this detailed plan, Liz has thrown a haymaker back at the critics who thought they had her stymied. Guess again - she has a plan!
And people need to also remember that Bill Clinton first proposed Universal Healthcare, and had Hilary trying to get it on its feet, but they failed. Yet that didn't stop Clinton from being re-elected.
What I'd love to see is for the media to clearly identify where they're getting their numbers and their arguments from, because I'm pretty sure they come from the entities that are currently profiting so much from the present system. The health care industry, especially the insurance and drug companies, rake in trillions of dollars, and that's jeopardized by MFA, You know they're using every resource (read: legal bribery, i.e. campaign donations) to try and stop MFA. And I believe they're using the media as part of that strategy. So, NYT: reveal your sources for these claims. I, for one, won't be surprised to see all of the big health care industry names on that list.
if warren wins and her mfa plan is unkilely to get anywhere in congress, what's the back-up plan?
Warren's plan raises a major question to Buttigieg and Klobuchar and Biden:
Why are you trying to make progress in the third decimal pace?
It is clear, by virtue of your favorable news and opinion pieces, that the NY Times is "all in" with the Warren candidacy. The implied innuendo and overt negativism toward others, especially Biden, is not well hidden. Why continue the subterfuge and just endorse her? At least that would be forthright.
1
If it was that big of deal, they'd contact me.
I think.
The article below by two Berkeley economists (one of whom received the "genius" MacArthur award) supports the points made by Socrates at https://tinyurl.com/yxq68fbj
Make no mistake: Medicare for All would cut taxes for most Americans, by Emmanuel Saez and Gabriel Zucman, 2019.11.25, https://tinyurl.com/y4eyos59
I've thought it through.
Turkey would start WWIII, and we'd finish it.
If you start it Turkey, we end it. You don't exist at the end.
I don't like Turkey if it doesn't show.
We can put Turkey out with one bomb. Guaranteed. One Bomb..
I don't know if Warren's plan will work but there is one thing that could be done. Pardon my euphemism but let me say this as clearly as I can:
"UNLEASH THE KRAKEN!"
"Okay John (you the reader say to yourself), it's official. You've lost your mind."
Bear with me.
Quite simply unleash the government to actually represent the People in negotiating all drug, etc., costs. What in the world is wrong with this idea? So what does this mean?
Set Medicare free to negotiate pricing.
I'll admit it's not a panacea, but it would be a good beginning in attempting to alter the seascape of the medical industry don't you think? Lord knows all costs are well out of hand.
It's time some organization, ostensibly one whose focus is on supporting the people and not the profit motivating schemes of private enterprise, play a little havoc with all the finely wrought plans of for profit enterprises. We the People have the power to make a change. So unleash the Kraken.
John~
Amercan Net'Zen
Until age 59, I had no major health issues. I hardly ever used my health insurance.
In 2013 I turned 59. I thought was lucky to have my commercial insurance nonetheless. Since I was (and still am) self-employed, however, I paid for it out of pocket.
I was a "young," athletic 59 year old, running 30 miles/wk and working out an hour each day at the gym. So when I had that heart attack while jogging over the Bklyn Bridge followed by a 10 hr multiple bypass operation, I at least knew my bills would be covered.
Out of pocket I ended up paying only about $1250.
Not bad, right?
Except for my premiums which amounted annually, with my platinum plan, to $750x12=$9000.
My medications annualized amounted to $285x12=$3420
My co-pays annualized for various doctors plus diagnostic testing approx. $135x12=$1620
So in a year I would be shelling out $14,040 (plus the one time event cost of $1250).
I am now 65. I have Medicare.
I pay, (including the Supplemental) $600x12=$7200
Doctors/specialists visits=$135x12=$1620
Medications (includes two not covered)=$180x12=$2160
So in a year I am now shelling out $10,980.
I need coverage for vision, hearing and dental. Medicare doesn't cover it.
Warren's plan covers the latter.
Losing employer-based insurance is a losing political issue right now. Every poll shows it.
If Warren can't get the majority to see how her plan does better than employer insurance, the GOP will do what they did to us in 2010 (remember "death panels"?) + they win.
1
@MICHAEL
Warren's plan, in terms of cost, would indeed by a jackpot for me. Especially as I have other health conditions that are also running inside of my aging body concurrently. And they cost a lot to address.
How will Warren convince the majority of Americans that Medicare for All will allow them to see any doctor they want, hence alleviating the fear of losing their employer-based insurance?
Polls show the vast majority of doctors are against it as Medicare's compensation rates for them are abysmal. How does she win them over?
What about the several hundred thousand people employed in administrative jobs in healthcare who will lose their jobs? How does she win them over?
Can she politically head the GOP off at the pass by anticipating and publicizing their arguments in advance and shooting them down?
Right now if we add Warren's poll numbers and Sanders' poll numbers together, we only get to about 50% of the Democratic primary voters. So Warren also yet to convince the majority of the Democratic base.
If she can demonstrate that she can accomplish these huge tasks, we need to all get strongly behind her.
Buttigieg's plan also get us there (my guess, in about 5 years). Without major disruption economically and politically. It has the support of the majority of the American population. And it can pass Congress. Once that happens, Congress can then keep moving the needle forward.
We need to win this election. Nothing is more important than that. Nothing.
1
“Probably won’t happen”? Did the author not read the proposal? $20 TRILLION. That’s TRILLIONS, ladies and gentlemen! It’s one thing to have aspirations and another to be out of one’s mind.
3
Now explain how forking over more cash to politicians would stop "Climate Change!".
1
People seem to agree that a buy-in to a public option, or what Buttigieg calls "Medicare for all - who want it" will do essentially the same thing over time as M4A.
It also has the added benefit of being massively less expensive initially and far less disruptive to our economy and healthcare system.
In addition, it has the benefit of being very popular and can help a candidate win an election.
It has large approval rating among people of both political parties. See polls below:
https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/
The opposite is true with M4A. It has the potential for being a polarizing issue that can be framed as a massive government takeover and it can potentially be very disruptive and is enormously expensive.
It is a proposal that could cause Warren to lose swing states and the election.
We can't afford to lose this 2020 election - we have to address climate change now!
So, to me, Warren running on M4A makes no sense at all, when a buy-in does the same basic thing and is a winning proposal.
Because of the need to address climate change now, the fact that she would chose to do this and risk losing the White House actually makes me rather angry.
I mean this is not just about me, it is about our children's future
She also knows that if elected that she is unlikely to get her plan past the Senate and as Krugman points out, will likely have to adopt the moderates plan anyway
Badly done. You fail to explain your main criticism. You say "I still think that a public-option-type plan would have a better chance of becoming reality." But you do not explain why. First of all if you do not make it a single payer like Warren plan does, you lose all the financial benefits of simplicity and standardization. You make no sense and seem to have some ulterior -hidden motive for fighting a single payer plan. Tell us what is really on your mind. Cynical me thinks you are siding with the private insurers who would stay alive on the Warren plan. This looks like severe prejudice to me and not journalistic honesty.
1
It's official. Just because Paul Krugman "approves" doesn't make it feasible.
2
Her plan you link is great, but is far too wordy for non skimmers. It buries the Lede.
Zoom down halfway down the page or CTRL-F to get to the heading
"PAYING FOR MEDICARE FOR ALL"
there she shows how the amount paid won't change
BUT
consumers will pay zero.
How's that??
"Right now, America’s total bill for health care is projected to be $52 trillion for the next ten years. That money will come from four places:
1. the federal government,
2. state governments,
3. employers, and
4 individuals who need care.
Under my approach to Medicare for All, most of these funding sources will remain the same, too."
The difference?
Those costs are shifted from 3 and 4 to 1 and 2
America used to be the country where we accepted challenges and made ideas work. Now we just target shoot ideas. Question: Why do crabs never escape from the bucket?
Answer: Because the other crabs pull it back down.
What the M4A progressive Berner bros fear with a President Warren is not that medicaire for all won't work. It's the paradigm shift that having a woman POTUS will mean, whether they say so or not.
@Sarah
I think many of "us" our fine with Tulsi.... It's not Warren's second X chromosome that's the issue - or even her policies. There are some an integrity issues... but certainly fewer than with Trump.
1
Oh Paul,
Socialism doesn't work.
It never has.
It never will.
If ObamaCare was so great why did congress FORCE people to join and then exempt themselves?
Seriously? You want a BIGGER disaster?
1
Whatever its merits, this plan will only succeed in getting Donald Trump re-elected. Any discussion of reparations for African Americans wilmake it landslide. Democrats, please tune into the mood of the country outside of New York and California.
1
I see Biden fading, at least in Iowa. This is too bad. I consider him a decent guy, far better than the average Republican presidential candidate and infinitely better than our incumbent brat/thug. He never was my top pick. I remember what Biden did to Anita Hill. We Democrats can -- and shall -- do better. And younger. (I'm almost as old as Joe.)
Are you really serious? Wait until she defines the Middle Class as people making less than 60K and then tells all the government workers that they are going to lose their sweetheart deal they have and have to join socialist healthcare. I am sorry but Krugman just doesn’t get it!
2
Hey Broken Clock—your column this AM was spot on! NOT! DOW 30,000—Trump 2020.
1
American's have an inalienable "right to life", as drafted by Thomas Jefferson in the Declaration of Independence, and adopted by congress, July 4th, 1776.
To ensure and insure this American right, what could be more appropriate and American than the adoption of some form of universal healthcare?
Isn't 243 years for Americans to wait long enough?
I think that this proposal by Mrs. Warren is totally irresponsible.
As irresponsible as the opposite view of allowing a free run to all health care providers, which is what we have now.
If we were starting from scratch, if we had no private insurers and we didn't have millions of people with private insurance either through their places of work, individually or because of Obamacare maybe it would be worth a look. But that is not the case.
Mrs. Warren is adamant, Medicare for all means that private insurers will cease to exist and that all of their employees, hundreds of thousand of them should be fired. Stockholders and other investors be damned. That is not a responsible approach.
And is even worse, it doesn't address the real problem, which is the excessive cost of drugs, and the abuses in billing by doctors and hospitals that charge for unnecessary procedures and even allow doctors who roam hospital's corridors so they can peak their noses into a patient room, uncalled and then send a bill in the hundreds or thousands.
The problem is not if the insurer is private or public is lack of management and vigilance. Set prices for drugs, procedures, hospital and doctor services that give a profit but are not outrageous and then do permanent computer inspections and audits.
It's not rocket science. It's only a management issue.
Yes it would. We pay less in taxes then almost any nation in the world. About 24% of GDP versus 34%. Our corps pay about 11% and many pay zero. In 1980 corps paid about 35% and workers 11% , now thats reversed. The High tax rate in 1980 was 50% and now way lower. We have billions being hidden by a very few.
Remember that the figures often do not include the money that we now pay insurers (950 billion) so some of that could be part of the plan. Canada has 74% government pay and we are at 64% NOW. Also, its not socialized government its a plan where the government pays the private sector to furnish care and they are regulated unlike now where they charge whatever they can
Pay for health insurance by adding it to FICA - we do the same with Medicare. This way, the insurance costs are tax-deductible - whoever pays, gets the deduction (for present employee plans, usually set at 70/30%, the company gets 70%, the individual gets 30%. Self-employed folks get 100%.) Capital gains income should be treated as self-employment - why it isn't now is beyond me. Also, minimum wage folks get to "chip in" the same percentage, making conservatives happy and also getting rid of the 29 hour cutoff for most retail stores. Increase the Federal minimum wage to accommodate the increased payment. Plus the under 26 year age for children can go away since they'll have their own insurance and will pay for it.
And with a FICA payment for insurance, Medicare just has to find sweet spots for the FICA percentage and cutoff income.
Medicare could let private insurance companies handle the billing and payouts, plus they could offer Medicare supplements for an additional fee - thus maintaining a lot of employment in the health insurance field, another conservative cry.
Keeping the payment proportional to income adds fairness without cost burden on the poor. (Just like Medicare!) Everybody and every corporation chips in - there's no more Walmart's holding working hours down to avoid insurance. I believe this is an elegant solution to paying for Medicare for All.
Warren for president because she is thoughtful, intelligent and younger than Bernie... He can be Secretary of whatever in her cabinet!
Something will happen... maybe there's an asteroid out there heading for earth.
I am happy with traditional Medicare and a supplemental (for drugs and whatever-- it never seems to pay anything else!) even if my bills this year are a bit higher than last year. I shun the Advantage (for the insurance companies) plans -- that is Socialism my dear-- already here.
I admire her tenacity and taking on the job of figuring out how this might all work. It is all a moot point as Americans are so idiotic that they refuse to even think about universal health care. Such backward "thinking". No one has ever reasoned with the public about real health care. Soon employees will be footing their own health care coverage. It has been sliding for years.
When will folks awaken? We need to become a first world nation rather than remain the third backward one that we are.
Health care for all!
2
Medicare for All is a slogan, nothing more. It sells on the left end of the Democratic Party but will get Donald Trump reelected in the general election. Most Americans are covered by health insurance and are not drawn to a system with so many problems (startiing with the fact that a significant percentage of doctors don't even accept Medicare). Support for Democrats should be soaring right now, instead most Americans are looking at these debates and thinking, "I can't vote for these people's policies."
1
The difference between Sen. Warren and all of the other candidates is that she is running as a President-elect and all of the others are running as just candidates. Looking forward to seeing that become reality in Nov 2020!
1
Warren’s plan ultimately doesn’t change the insurance landscape - health insurance is largely employer - sponsored and clearly it is to remain especially when so many critics say we should move away from it. I’m also curious to here if Krugman would discuss the effects of drug costs going down in the US against drug innovation. Would he predict the situation that we currently see with a lot of generic companies where they no longer bother to produce life saving meds because there is no profit to be gained?
Medicare for All is too extreme. It won't sell. There are two primary issues that need to be addressed with respect to health care. The first is Medicaid expansion. We shouldn't be relying on state governments to choose expansion. Medicaid expansion should be nationwide. The second issue is with the cost of prescription drugs. If a doctor prescribes a drug, we should be able to afford it. The price we pay for drugs should be tied to our ability to pay. We don't need a whole new health care system. Many Americans are satisfied with their private insurance. That's why Medicare for All won't sell. If the candidates would just focus on those two issues, they would be more electable.
2
Is there any discussion more convoluted, fallacious and deceptive than the health ‘care’ debate? Of course everyone wants something for nothing. But there is no entitlement to any government service with spiraling costs in the near term and literally infinite costs over the long term. How many other things do we get in life without having to pay for them? There is a groundswell of support for the idea that people should not have to go bankrupt when they get sick. Fine, but where do you draw the line on which specific treatments and procedures are included? Proponents never get to that point in the discussion. The only serious debate is about defining what is paid for and what isn’t. At the core of such a discussion is the choice between individual adult responsibility and infantile greed. Beware of politicians and Nobel laureates pandering to non-grownups of voting age.
1
The flaw in your reasoning is that healthcare isn’t guided by the usual market forces. If you need a car, for instance, your choice is based on what you can afford. You might not be able to afford a BMW, but you could manage a Honda. Or take the bus. But one can’t choose which illness they can afford,or what treatment they need to combat it. It is inhumane to deny treatment to someone because they can’t afford it. Insurance spreads the risk throughout the population so no one person is left holding the bag. Or dying as a result. And it’s not “Healthcare for nothing”, it’s spreading the costs throughout the population. But we don’t care about anyone else as long as “I have it, who cares about you?” Which is a sad commentary on our society.
@Maggie T You wrote: 'It is inhumane to deny treatment to someone because they can’t afford it.' A noble sentiment that avoids the question of precisely how much treatment we should be willing to pay for. When you buy your BMW or your Honda, do you expect that a few thousand people should kick in a buck apiece so that you can get one for free? Would you consider them bad people if they refused? Catastrophic-only health insurance (which is all anyone truly needs,) has been calculated by actuaries at a cost of less than $50 per month per person. I would gladly participate in a healthcare system at that cost. Caring about people includes encouraging them to grow up and act like responsible adults and generally pay their own way. Otherwise the streets might become awash in homeless people seeking the next handout. That would be unsustainable and a grievous error.
1
The problem is that health insurance companies are conflated with the capitalist bromide of the wonders of the market place. And Medicare is a gov't program that provides a less expensive more comprehensive coverage. The health insurance industry can continue to promote that a capitalist solution is always superior to a big gov't one. Plenty evidence exists to the contrary. The ACA was a hybrid private health insurance system that forced to a certain extent them to look at the consumers interests before there own. But still private health insurance company's high overhead costs add too much to total cost of health insurance. Capitalist solutions are often inefficient and work against more people being insured. One is still left with too many people on the outside looking in.
1
To duly reverse trends which ignore running out of losers to whom capitalism's requisite "liar's poker" needs to lie, visionaries like Elizabeth Warren obviously take into account the missing entanglement for which higher returns literally expand our Gross National Happiness.
True, stock-optioned quarterly reports may accurately reflect who's got the best lemonade stands. But to prioritize this over R&D of what can withstand the test of time unduly inhibits uncertainty's far greater check.
After all, particle stays preclude waves never waived. Hence longing our equality's quantum sate to which marginalized capitalism can't point. Therefore, per Elizabeth Warren, only the synchronized 'murmurations' of democracy's far greater flock can paint-by-number what follow-the-dot groundswells can only rig.
One day, we will have universal healthcare in the United States, and all those who voted against it will still benefit from it, as will their children and grandchildren.
Just as they themselves or their parents are now benefiting from Social Security and Medicare.
Or just as we are all still benefitting from infrastructure built by FDR's New Deal.
3
Mr Krugman thinks that if she is elected, Ms Warren will push for a public option as that is more realistic legislatively.
So why is she jeopardizing her electoral chances by telling 125 million Americans, who have employer provided health coverage, that their current insurance will terminate and they’ll be thrust into a totally undefined mega plan run by the government?
To me, that’s political suicide. What is she thinking?
4
@Peter E Derry
I agree. I think the attacks on her plan from both the left and right are predictably simple:" $20 trillion! " Conversely the explanation and defense of the plan are complex. It's a conundrum . It may be bad politics but I respect her for her conviction. I think Senator Warren just gave Mayor Pete a big lift.
2
What I wonder about Sen. Warren's "medicare for all" plan is this: if all medical and drug bills are covered by this plan, does that mean that there is no need for such coverage under the various state workers compensation systems and no fault auto insurance systems? My surmise is that these two systems cover a substantial amount of these medical bills and thus the nullification of these systems should result in substantial savings for employers and auto owners. It may be that under Warren's plan these systems remain in effect, with the new medicare system applying only to the extent of any gaps in the system. I think this is an important issue and I would like to see it addressed by politicians and commentators like Mr. Krugman. (I am aware that workers comp systems apply not only to medical expenses but also to lost earnings, an element that presumably would not be covered under the "medicare for all" proposal.)
1
The United States needs a president who supports single-payer health care, clean energy and the Employee Free Choice Act/unionization. I will not vote for another twerp who wants to 'reach across the aisle' and compromise our lives. I'm tired of being hammered by huge medical bills, blazing heat and low wages.
10
Warren's plan is like Trump's wall plan: pie in the sky red meat to the rabid base. It's games and nonsense, but if she gets elected the fantasy will be used to justify other ends, like instituting massive tax hikes on every white makes making over $100,000. Warren's plan is lunacy. We don't have this kind of money, and we haven't paid for the free college yet! In a sane world Amy Klobuchar and her non Twilight Zone residing public option plan would be all the rage and perhaps we could return the presidency to the land of sanity. I guess we're in for 4 more years of Trump. At least my taxes are lower!
1
@MJG - "every white makes"? i'm guessing you meant, "every white male," and that right there sinks any possible credibility you might have to opine on health care plans, any possible plausibility in your claim to be interested in Klobuchar, or any denial that you're not going to vote -- again, and eagerly -- for Don Trump.
1
warren's a coward for not raising taxes on the middle class. After all they will no longer have to pay health insurance premiums or co-pays.
@joe Anyone who believes that their taxes won't be higher under a scheme like this, whether by Warren's choice or not, must also believe in unicorns and leprechauns.
2
This plan is going to guarantee Trump's re-election.
4
Krugman nails it when he says, "Warren passed the test." Of course, her plan is challenging but an initiative of this magnitude
will always be. Does it sway voters? I think the prospect of a mandated plan for many who currently like the health care they have will turn voters off. By election day, Warren will need to modify her plan to allow for opting out in order to attract voters who would otherwise support her.
2
@Gregorio "By election day" will be way too late. Warren disqualified herself as someone to be taken seriously the minute she embraced the "do away with private insurance" fantasy.
1
2 cents to these billionaire's dollar is spit in their bucket. It will pay your health insurance and me. Refurbish our aging infrastructure and built the Gateway project. It pays off the impeachment of Donald. Bon Jersey.
5
Three questions: under current Medicare, insurance companies offer supplemental coverage and thus have a role; would that role be eliminated by the proposed plans? And if there will be a continuing role, won't that prevent the complete loss of jobs at the insurance companies? Will the employer contributions insure the benefits union members have bargained for in their contracts?
Two facts that support a Medicare for all approach: We have the healthiest old people in the developed world and the sickest people under 65. Medicare works!
4
@Dianne Karls Must dispute the 'healthiest old people' premise. I checked world health statistics and, for example, French women live 4 years longer than American women and French men 2 years longer. (They're not as overweight and they walk more. And drink wine!)
@Dianne Karls Darwin nods. Only the strong survive our system and make it to 65.
@Dianne Karls Evidence for your assertions?
The ONLY health care policy we need is to mandate that voters get the same health care that members of congress gets.
Problem fixed.
5
I was impressed with her details. Although I am not a Warren supporter, her plan details do warrant serious discussion. The rollup of Medicaid into a Medicare expense level will cause serious underfunding. HOWEVER - any plan by anyone will have its shortcomings and criticisms.
Unless we as a nation bring our drug pricing in line with the rest of the world's (or better) -- our healthcare system will always be far more expensive than the rest of the world's.. regardless of the label or name we give it.
I must give Senator Warren two thumps up for coming out with something solid on this critical issue.
9
And trump's answer is another tax cut for the rich. I bet he doesn't have to go through this same scrutiny to pass it. His plan, just like the last tax cut for the rich, will just increase the deficit.
4
The one payer system (like Canada) is the cheapest way to go (many studies have proven that) The biggest thing you have to fight is big pharma and private medical insurers. They tried to wreck the Canadian system when it came in in the 60s and failed. Thank goodness. It's all about greed. Recently I spect 3 visits to emergency and cat scan blood work etc. I didn't pay a dime. My husband and I do pay I think $100.00 premium and that's it. The biggest saving with the one payer system is administrative. Go for it America, if we can do it so can you!
14
@Melinda Huntley For better or worse, we don't have your government or political system. And the 1960's, with its boom economy, were over a while ago.
3
We don’t want to be Canada (believe it or not).
1
Three words: "plus climate change!"
Medicare for all is a side show.
It won't matter if sea level rises.
Continuing civil society requires action now.
5
@Mr Pb 80% of the republicans don't see climate change as a serious issue and they all support trump. Until these people start living in the real world, not much can be done. Our election system highly favors the republicans controlling the senate and winning the presidency.
2
I, an immigrant to the USA, hate Trump, but I have a fear of us Democrats trying to turn the USA into Canada.
Why do I have this fear?
I have always believed in American Exceptionalism as being this: The USA is alone amongst first world nations in being able to take in people who have nothing - no education, no possessions - but the desire to work hard (very, very hard) to improve their lives, and to then provide an armature that supports that, more or less. That has been America’s secret weapon.
I’ve noticed that in “socialist” developed countries, a fixation emerges on admitting only immigrants who can immediately pay their taxes. By having more “on offer” in terms of social safety net for the society, more concern emerges about who may abuse that, and hence who should be admitted. The USA, by offering little other than an entry, has historically avoided that.
I thus worry a lot that becoming like other industrialized nations will take away America’s secret sauce. I don’t want us to end up admitting only people who have made it. They are not nation builders.
4
@PHS My husband is an immigration consultant and work with refugees regularly and what you are saying is not true.
There are many things exceptional about the USA but not having a universal medicare for everyone is backwards.
5
Leave aside refugees; they make up a small number in any industrialized country when seen over time (leaving aside the recent anomaly of Germany).
Refugees are the exception to the rule that are carted out by ALL sides (including Trump) to try to make a case about the rule. But this is spurious. I’m talking about all other immigrants.
1
@PHS You're certainly right that immigration has helped the US's economic development. Cultural too. It is not "socialists" but Trump and the Republicans who have proposed limiting immigration to those who will be immediately self-supporting. And only the most highly educated professionals among them. The European countries have dropped internal European boundaries to travel, work and trade, and have also admitted millions of immigrants and refugees from the Mideast and Africa, and are struggling to adapt. In the long run this will be a strength, as you suggest.
2
Assuming she becomes president, I believe Warren's plan will sink or swim depending on how the plan negotiates around the fact the private insurers have a strangle hold on health care financing.
Their collective political clout is so enormous that they will of course fight tooth and nail.
Warren's chances for success may hinge on how she can implement Medicare For All while still letting private insurers have some skin in the game.
After all, right now Medicare for seniors is really administrated by private insurers working with Medicare to provide health care for seniors. At least it is so in my case.
1
@ernieh1 I don't think we need to feel sympathy for private insurers. They are some of the greediest of our corporatocracy. Skin in the game?! I think they've taken quite a bit of the skin off the back of Americans for years.
2
@Jill H It is not a question of sympathy for private insurers. I have no sympathy for them. It is a question of whether any Medicare for All bill can cut them out of the system entirely. Their strangle hold is too strong.
It is a question of politics in the real world.
@ernieh1 You make a good point. With $100 million a day to spend on lobbying, etc., the private insurers will be hard to pry loose of their influence over our elected representatives.
Our Dem primary is not about policy, but about two competing ideas about the electorate. The moderates say we must win the middle in order to take over governments on the state and federal levels and we win the middle through incrementalism.
The far left says we need to bring in young voters in order to bring in deep and meaningful changes in government. Now the stats say that for the last 50 years, young people talk and talk, but the fact is, you get many of them to go in the street and riot before you get them en masse to stand in line at the ballot box. Our governments are run by a bunch of old white men precisely because the young don't vote.
Essentially the far left is declaring a meteor will hit the earth and kill all the dinosaurs any day now...and our real problem is, when that meteor does not come, we are stuck with Trump and a bunch of mean old white guys dismantling our safety nets and giving welfare to the rich. Warrens ideas are great, but who really thinks there are a bunch of high school seniors chomping at the bit to rush out, register and vote for her?
1
She has given Trump what he needs to feed Democrats through the wood chipper in ‘20.
Strategic blunder of the first order.
4
@PHS - maybe you're right. maybe spinning wild lies and inflaming racism is really the way to get elected in the USA ... oh, and frying bacon on the barrel of a military firearm.
well, i want to see the test. i want to see if lying can be fact and reason in the voting booth. i'm looking at real estate in New Zealand, just in case.
"plus climate change!"
Yes!
This has to be the #1 issue. And it's so easy to beat the republicans on this, and to inspire youth, and many other big groups. We know that climate initiatives can also drive the economy and innovation. It's not one or the other. Look at CA, Norway, etc: strong environmental initiatives, strong economies.
2
Warren’s sales pitch should be simpler. “It’s like Groupon. You pay a dollar more in taxes and save 3 in insurance bills”. People can understand that.
One often expressed worry in selling this plan is that we don’t want to take insurance away from people who “like their current plan”. And who is that, exactly? Everyone I know hates their plans - the premiums, the deductibles, the exclusions.
My solution would be to put everyone on Medicare, but allow people to opt-out if they like their plans. It won’t be long before people see the simplicity and coverage of Medicare, and switch.
To be fair, I do have concerns about the financial strain this would put on hospitals, solo practitioners (I’m one) and the many workers in the insurance industry. Any plan must address these issues.
3
@Mark Ask your local hospital and physicians how much of their labor costs are for people whose exclusive jobs are to barter with insurance companies to seek reimbursement for their services. Many hours are spent by health care workers in documentation to satisfy private insurers' requirments for reimbursement. Documentation time has affected those who care for patients, taking away from the time that would be better spent actually treating their patients.
1
I am not an economist, neither am I an American but have enjoyed single payer for almost half a century half little tolerance for the lies and distortions of America neoliberal right.
There is no perfect system that works for everybody. I looked at what was being offered from the perspective of insurance company CEOs and rated medicare for all, no government involvement, today's medicare and opting in at fifty.For those selling insurance the best system for their bottom line is opting in at 50, second best was what we have now, third best was no system at all and worst in terms of their greed and power was medicare for all.
I cannot imagine anything worse for the promoting the general welfare than taxpayers paying the freight for those born with chronic conditions and those over 50. It is most of the cost with very little social benefit. As a Canadian I wonder who thought this was a moderate solution when insurance companies enjoy the revenue and taxpayers foot almost all the bills.
It is enough to see the windfall of the current system where taxpayers foot the bill for seniors while those in the prime of life with the least expenditures pay the premiums for the services they need the least but as I watch American politics I know misinformation is job one. What kind of thinking went into deciding opting in at fift was moderate when it makes real advances more difficult as insurance companies enjoy another windfall.
2
The fact that Elizabeth Warren is scaring the bejeezus out of the Wall Street crowd should be reason enough for the rest of US to support her.
I would encourage her, and Bernie, to get more specific on the amount of money spent on golden parachutes, and stock bonuses, and stock buy backs, and all the other goodies that we pay for with out insurance premiums. Insurance premiums should be reclassified as "taxation without representation".
I remember that slogan getting pretty good traction during another one of our Revolutions.
What energizes me about Warren's campaigning is the Joy she is bringing to it; a love of the people she is connecting to; and a love for the process she is exploring.
We the People have no choice but to break the bonds that the corporate masters have chained us with, and that means their paying their fair share of the expenses and it means that they stop getting an unfair share of the benefits.
12
You obviously grade on a curve.
2
Medicare for all, no thanks. I will keep my insurance and my money. 52 Trillion, this woman is nuts. Go away!
4
@Chris
Medicare for all who want it will lead to a win, as will the result of those who choose it winding up better off than those who don't.
In five years, that eventuality will result in Medicare administrating the nation's health care system for 2% instead of the private insurance sectors' 18% and up.
5
There are not a lot of numbers in this opinion.
Given that the conclusion is faint praise and the author is extremely skilled with numbers, my interpretation is that it is damning with faint praise.
2
Warren plan of Medicare for all ages is seriously flawed. T hose who do not understand the complexities of the current Medicare for all above the age of 65 will find out that Medicare for all ages will be just not feasible, practical, optimal, sustainable or even essential.
Warren though at least has a plan that seems to have catapulted her to the front runner status in Iowa leaving Biden far behind. Bye bye∂ Biden good bye. A mediocre career politician is fading away and it is his own damn fault. He has allowed his party to move to the extreme left abyss since Obama Biden left office and Obama has already warned the nation about it. After losing Iowa and possibly New Hampshire, Biden should call it off for several reasons and the Bidens role in Ukraine may not be even the top reason. .
3
@Girish Kotwal
I have had Medicare for three years now. I had spinal surgery in January, a big deal. Thank God I had Medicare. Nothing complex about it all. I have no idea what you are talking about. Everyone should be able to have what I do. We are the only country that doesn’t have universal coverage. It is doable.
5
@Ernest Ciambarella from Cincinnati. Glad your experience was great and I hope everyone above 65 with Medicare can have a similar experience. But will experience had been the same had it been Medicare for all ages? Firstly your waiting period could have been much longer and you may not have received the same undivided attention and the same availability of rooms. I agree that there is no reason why US should not have universal health care but Medicare for all would not be the answer that is my opinion knowing how government functions. Medicare is just an insurance it does not equal private medical care and that will vary with different place.
1
In other words, I should vote for Warren because her signature program is not going to pass. This is hardly a recommendation. I lived in Europe, Hong Kong and Israel, all of which have universal health coverage achieved by different means. While they are undoubtedly preferable to the clunky American system, they have no similarity to the monster Warren proposes, which would outlaw all private insurance, kill medical research and raise my taxes, so junkies and homeless can have the same coverage as myself. My preference would be for a bare-bones program financed by a designated health tax, which would be paid by everybody, including people who receive any kind of governmental assistance. Sure, it would raise my taxes but at least I won’t feel that I am paying for free riders. And of course, the notion that M4A can cover everything is nonsense. In every country with universal coverage there are limitations on the kinds of treatment and delays in receiving them. This is why supplementary private insurance exists. Warren is a demagogue, and her plan is simply a cynical political slogan to rally the left-wing radicals - and alienate everybody else.
2
@Mor You do understand that the current medicare system is payed for by everyone, right? SS and Medicare taxes are the same on all earned income. Most people suggesting tax increases on the wealthy do so because they've intentionally shifted as much of their income towards things that don't pay that tax, an option the poor and "people who receive any kind of governmental assistance" don't have.
14
@Brandon There is no definition of “wealthy”. It is a dog- whistle, not a serious taxation category. Every time I hear Warren’s screechy voice denouncing “the rich”, I know I am listening to a demagogue, not a politician. And Medicare is not free, as far as I know, nor does it cover everything. Extending some form of basic coverage to everybody is a good idea but if it is paid for by soaking the wealthy, stoking class antagonism and and denying choice, I am against it.
@Brandon No, the taxes aren’t the same. Taxes on Medicare have no income limit. You do understand that, right?
Tying healthcare to employment needs to end. Full stop. I don’t buy my auto insurance through my employer and I don’t want to buy my health insurance through my employer. 
14
@JimT and above, how can any one compare car insurance with health care or peoples lives? Reducing your line of thought, not everyone drives, but all will need healthcare. How cold. As to most of the rest, it sure looks like ignorance drives many of the negative views here; you may not have heard, but our current healthcare system is breaking the economy and is still the number one reason for bankruptcy. Making a buck off the misery/health of others is amoral, and the EU has show us all how socialized medicine costs less, with better results, just by life expectancy and infant mortality rate comparisons. Regarding ignorance, Jimmy Kimmel’s bit, “which do you prefer: Obama Care or the Affordable Health Care Act” said it all. The idiotic idea that business is better at running things is another canard, the only purpose of any businesses to make money. Maybe this will help: Looking to the future, Government left to the Democratic’s looks more like Star Trek, while government left to the republican’s looks more like Blade Runner.
1
Marianna Williamson is right— we need to talk about HEALTH care — diet, water, air, exercise, sleep, all of it.
4
Dr. Krugman,
I agree 100% with every word of your column - perhaps a first, but a compliment nonetheless.
Sincerely,
D. Parsons
2
Reminds me of voodoo economics. Sad to see how a well regarded economist has become a partisan to such an extent. Does anyone have a simple math exposition of this “plan”? How is it affordable?
You know 1 +1 is 2 not 5. That would expose this plan for the leftist, acid trip that it is. Well, party on, till the next recession.
5
'Medicare for all is Medicare for none!' Have the republicans copyrighted that yet?
2
Bernie 2020, but Warren is a good choice
4
@Joaquin Hamdan
I love Bernie but we need to elect somebody who can run for two terms in office.
I personally do not endorse free college tuition nor Medicare for all at this time. Fortunately I doubt either will be realized in the next decade so I can happily vote out Trump despite the campaign rhetoric. I do, however, favor tinkering with the system to improve outcomes starting with plans such as interest free loans for college tuition as long as payees responsibly pay their monthly installments on time. I very much favor closing the Social Security tax loophole by eliminating the salary/wage ceiling and adding graduated tax contributions to higher wage earners and lowering the contribution for very low wage earners. I also favor opening up Medicare to persons 55 and older as a start toward a complete overhaul of our heathcare delivery system. This system is exceedingly costly with barely acceptable outcomes for most people and as consumers of healthcare we should be outraged rather than sheep led to heathcare slaughter in the name of barely discernable "heathcare choice" for anyone but the wealthy.
7
The Japanese have a good health care system with some private insurance. Why can’t we look at that for a model? I think the reason that it’s ignored is because the Japanese government controls the cost and profits, thus not allowing it to be the road to riches for special interests. Our healthcare system is predatory capitalism sanctioned by the government. Government workers get good healthcare that we all have to pay for. The system is broken and needs a complete renovation.
12
I think that we underestimate the effect of removing health insurance from the for-profit realm, which is more than simply taking profits back from the insurers. Consistent profits are not enough to support stock prices. Publicly-held health insurers have the same Wall-Street-driven impetus to generate quarter-over-quarter growth that other public companies do, lest their stock prices fall. In order to generate the market-required growing profits while maintaining their "take" at the politically acceptable 3 or 4% of total premiums, those premiums must continually increase. This means that commercial health insurers have every incentive to keep premiums growing, and none to keep them steady or dropping. Take away profits AND stock price pressures, and then it's a different world where Warren's numbers work.
9
@Sagebrush controlling profits is also called socialism.
1
@Socrates
Enjoyed your excellent insights and comments.
Another “best part” about Medicare 4 All that Dr. Krugman left out, contrary to what some commentators here are confused about, is that people will be able to choose whatever doctor, hospital, or clinic the want, and change if they want. They wouldn’t be told by their insurance company which “panel” of doctors they are limited to. This would only improve healthcare and the service, because the better the physician or hospital is, the more patients they see and care for. The poorer performers would lose patients. The doctors work for themselves and not on government salary, just the payment would be from the government.
10
@Time - Space
Excellent point, as the question of choice, or lack thereof, is one that opposers stress constantly.
7
@Time - Space
Yes--Elizabeth could throw this in Mayor Pete's face the next time he says "Americans like choice." The only way I get choice on my current private insurance plan is to go out-of-network and pay extra to get some reimbursement. Not quite the wonderful world of choice Mayor Pete seems to be trumpeting!
2
Prof. Krugman - The plan is pretty clear on one thing : The government as a buyer of last resort can command cost savings because of its buying power and legislative prowess. It is not, however, even reasonably clear on the overall cost of such provision, i.e. $20 trillion. If as she points, rather vaguely, that much of that cost will be paid for as a result of increased corporate taxes then fine. But will such increases take us back to the pre-Trump tax structure (ok) or will it increase the burden over and above the Obama era (not ok). If the plan is the latter then please be assured of one thing : Corporate America will simply coalesce to moving into tax shelters and states with low tax bases and incentives.
Rather than expand the base around which talent is situated in our country, we will simply end up driving most of it to states like Florida, Kansas and Texas. We will likely have "Flint" and "Gary" sized pockets everywhere in our country.
You can call it the law of unintended consequences if you may. But it will happen regardless.
I realize that discussing the philosophy of tax increases is fashionable in academic circles but it does extract a burden on all of us.
Oh by the way, in all this : I did not see a proposal to decrease our 2020 defense spending of $718 billion which has historically escalated at around 7.5% a year. Maybe we can curtail that and pay for the cost of universal healthcare? Just a thought.
8
@Plato Sounds like it may be time to prohibit tax shelters. Corporations should pay their fair share instead of battening on the public commonwealth. While much of America was reeling from the 2008 crash, corporations were getting bailed out by the taxpayers. Goldman Sachs contributed substantially to the crash and was essentially made whole, executive bonuses included, while millions of Americans lost their homes. Time for regular people to get first consideration.
4
The real health issue is long-term health care whether it be in an nursing home or at home. The government is ignoring this immediate crisis. This is currently unaffordable and will tremendously burden any health care decision for future care.
3
Why let companies that do not offer health care off the hook? It makes no sense to reward them for screwing over their employees.
2
@MollyG Why should companies be responsible for their employees' health care at all? Our antique WWII system is a big part of the problem, not the solution.
Just saying that we are going to tax businesses to pay for this is a pretty empty workaround. Businesses pay almost no taxes now aside from payroll taxes. You would have to revamp the entire tax code first which would be a major undertaking. Just blithely declaring some new tax on businesses is complete fluffery. Get real, Liz.
3
@Patrick Businesses pay no taxes? Where did you get that idea?
@Patrick Obviously, you missed the part where businesses’ new taxes correspond to what they are paying right now as employers ‘ contributions to employee health care... sigh... That means they will pay no more in taxes than they are already paying right now!
2
@headnotinthesand
Well, check out this link on Walmart Employee Health Insurance:
https://www.indeed.com/cmp/Walmart/faq/how-much-does-the-health-ins-that-walmart-offers-cost?quid=1b6ipudmuak97fbk
If that is where the money to pay for Warren’s MFA Plan is coming from, looks like there will be a humongous deficit. Don’t you agree?
So how do we raise Walmart’s taxes?
She passed the test? Krugman you know this is DOA.In a perfect world if the Dems run the board in 2020 do you really think this has a chance of passing? Cutting the military, forcing employers to now pay the government for healthcare and taxing the rich? Are we living on the same planet? Passing ACA was political suicide for The Dems when it passed.If Warren is the nominee in 2020 Trump will relish her plan.Before this plan gets baked into the cake it needs to be called out for what it is. 180,000,000 Americans don't all hate their plans.Have we forgot how the rollout of The ACA crashed? Trump's coffers are overflowing now can you imagine what happens when rich Dems and Republicans see Warren's plan? Do we want to change the world or beat Trump?
5
So if I was a billionaire and President Warren (yikes, just writing the words produce chills!) somehow, someway gets her uniquely un-American socialist plan realized, I would just sit by, keeping all of my assets in the United Started and watch them confiscated slowly by her insatiable need to impose a State run medical system on 160,000,000 citizens who are perfectly happy and secure with their current healthcare.
Not.
One need only look at the declining populations of high tax states as the wealthy flee from New York, California, Massachusetts and Connecticut in order to protect their private assets from socialist confiscation to know that her plan will fail.
"Socialism works until you run out of other peoples money." Margaret Thatcher
4
@Carol wood That's why I know you will be refusing your social security checks and medicare when you retire because socialism doesn't work.
11
@Carol wood
I am my family enjoy virtually perfect health, follow good diets and life styles ... and yet our premiums and co-pays continue to increase above inflation, and coverage continue to shrink. And every year we get shifted to the newest lowest-cost provider in town.
Count me out of your pool of 'perfectly happy' citizens who have health coverage through employers.
What you call 'socialism', which I call 'less inequality', seemed to work well until Thatcher and Reagan showed up.
3
@Kurtis E We paid for those benefits, Kurt. If you would like to refund my forty years of payments, I would gladly opt out.
2
Warren's plan assures a shortage of providers down the road. This is America, where the brightest minds can demand the highest paychecks. Not every country has a Silicon Valley into which people who would otherwise be good doctors can disappear. Yet cutting the incomes of providers is part of Warren's plans, because she resents how much they make.
And a wealth tax will be impossible to implement. It's tough enough to evaluate an estate at death for what could be a significant piece of revenue. (I support dynasty-busting estate and gift taxes.) But to do it every year? For a relative pittance? That's just vengeance on stilts.
To me, Warren and Sanders and the Squad and Trump are all of a piece: they define themselves not by what they favor but by whom they hate. Same brain, different scapegoats. I'd like to say we can do better, but the jury's still out on that one.
6
How about the shock to an already stressed system? We have a drastic shortage of Doctors and nurses now. Has this plan really been thought through? Can the system handle everyone covered in four years?
6
I have been practicing as a primary care physician for 49 years and I still love my work.
I have never had a patient who had Medicare and said that they wish they had their old 'private insurance'.
I suggest we reconsider the offering.
A single party payer or catastrophic health problems. A catastrophic health problem will be defined by experts in the specialty field of the problem, medical economists and medical ethicists. This problems will be managed by center of excellence of which we have many throughout the country; think Cleveland Clinic, Mayo Clinic, Johns Hopkins.
This removes a great deal of uncertainty from private insurers and should lower premiums significantly.
A health savings account with means testing can be offered for non-catastrophic medical care. A person who tests for financial need will receive a chit from the government (fed or state) for a plain vanilla HMO. They must participate. The HMO will be assigned to them if they do not choose one. The HMO will only be paid if it actually reaches out to provide appropriate preventive services.
People will have choice. They can spend their money on a good basic plan or buy an expensive/concierge type plan. Insurers can stay in the game, BUT, they must be transparent. No more shell games.
Much more on drug savings but I will stop here.
5
@Warren Ross, MD
But why keep things so complex? Simplicity and transparency, and cost savings, in my opinion, are the desired and achievable outcomes of a single-payer system. And the whole point is to reduce the economic drag of health care. In addition, the opportunity to shift the provider community (perhaps further) philosophically from emphasising sickness services to emphasising preventive services could, it seems to me, change the game for the better.
1
@Warren Ross, MD
Here's one who wishes for the old days of private insurance. I've been covered by employer insurance since I was 21. Now I'm on Medicare, and I've never paid so much for health insurance. Between the Part B and D premiums, plus the upcharge "penalties" (which happens if you have even a small income and savings/investments) plus the Medicare supplement--it's close to $500 a month. And I've learned that many docs do not take medicare. Because the reimbursement is so low it places a priority on "productivity" and patient volume to compensate and many do not wish to practice this way.
These changes to healthcare will save lives and $ for our nation. Obama’s ACA, basically Romney’s Massachusetts plan was the biggest gift for Americans since LBJ’s Medicare. It’s worth doing. Reagan screamed socialism and the end of America when Medicare was passed. He quietly decided it was ok when he ran for president. Warren can help us Do this.
9
A candidate whose principal platform is free medical care, free college/debt forgiveness etc is not going to win the presidency. It is just not going to happen.
9
Whatever happened to our can-do spirit? If the current can’t-do spirit had characterized our nation throughout its history, we wouldn’t have transcontinental railroads, the interstate highway system, Social Security, Medicare, or the Internet. In fact, we wouldn’t have most of the things that enrich our lives. In the passion with which Senator Warren argues for her healthcare plan, I sense the spirit that truly made the United States great.
8
I think not - there are so many unintended consequences to this plan I can't begin to count them - but let's start with physician attrition - if you think its tough to get into see a doc now, wait until this plan comes about. Just about every doc over 55 - will likely cash out and walk away from practice rather than lose money on trying to manage the costs of fixed capital investments such as all the technology, equipment, etc. at Medicare only reimbursement rates. So what's the big deal with eliminating all private practice medicine - a lot since about over 50% of specialists are in private practice. Need some surgery - may be waiting a couple of years...we already have a acute physician shortage in the US - with the Medicare free-for-all - well have many fewer and we'll see rationing in healthcare like you could never imagine. That's one. I have a few hundred others...
5
We need to rethink how long medical school training is along with sky high tuition costs.
Med school could be shortened by at least one year.
Costs of schooling have to be
drastically reduced.
and we could be training many more Physician Assistants and nurse practitioners.
Keeping people out of the workforce for all the years MD’s
train, ensures a shorter work life.
Many doctors complain of huge amounts of documentation. I think that can cause more burnout along with people seeking cures for everything that ails them.
We will get a better system but it will take a few generations.
2
HOPE AND FEAR.
Our great nation has many strengths, yet innumerable systemic barriers to fully realizing its true potential. Our health care system is one powerful example of how we allow our belief in the free market and capitalism to fail us. While many HOPE effort and hard work is enough to get rich (the American dream!), they FEAR the callousness and hopelessness of the corruption and greed that drives our broken governing bodies. I know countless people with great ideas for businesses, who would love to further their education, who dream of doing big things, but who cannot afford to purchase health care. I know many young, brilliant, driven people who have an ailment - some unknown pain or potential medical issue but who don't go to the doctor for FEAR the cost in medical bills could derail their HOPES for the future. If healthcare were a right in America - like it is in most of the rest of the developed world - it could be one powerful step towards unleashing our entrepreneurial and business power. But alas, in service of the already rich and powerful, we fail to unleash our potential. Yes - we need the courage, tenacity and intelligence to fight for our great Nation's potential. Warren may have what it takes.
9
@David
I completely agree. So much human potential in America is stifled because of fear of losing employer based health benefits. We are literally stuck at jobs because of fear of medical bankruptcy. I wish Liz would make this argument, maybe get Yang on her team who is thinking in a similar direction in trying to free human initiative from the shackles of sub-par wages.
2
It seems to me that one of the problems with the ACA is that it's separate from Medicare; the USG now operates at least three separate health care programs: the ACA, Medicare/Medicaid, and the VA's Tri-care program. A serious reform might be to find a way to integrate them under the supervision of the Health and Human Services. I'd think that disabled vets --- at least combat-disabled vets should be receiving health services in military hospitals or as outpatients from those, and the rest of the VA health system should be merged into a reformed Medicare. Tri-Care for retired vets also should be merged into Medicare, and so should "Obamacare."
3
I really think it doesn't matter. 2020 is shaping up to be a repeat of 1968.
In 1968 Eugene McCarthy was the clear choice of the people. Hubert Humphrey, then Vice President, was selected in a back room without ever running in ONE Primary. This accomplished electing Richard Nixon for his first term.
Warren will emerge from the Primary as the clear choice of voters and then the Democratic Party leadership will run scared. The powers that actually matter in decision making are still Third Way Clintonistas who will refuse to give way. This is what Super Delegates was designed for, to thwart whomever the party leaders feel is inappropriate.
This is the reason I am an Independent. The Democratic Party leadership are like petulant children who would rather take their ball and go home than be actually "democratic".
8
The principal benefit of Medicare for all is the creation of a single risk pool for very citizen and legal resident that is comprehensive, portable, and based on a public non-profit administration, as Krugman acknowledges. Even if Warren's plan doesn't pass, she opened a conversation that should have never died during the Truman administration and that of Republican governor Earl Warren in California. Both leaders recognized universal coverage will become more difficult to pass as Americans rely on private health insurance.
However, Mr. Krugman misses three points. 1. Allowing people to buy into Medicare who are uninsured or have paltry plans that limit medical care runs the risk of destroying Medicare through adverse selection, and as Ben Franklin said on another topic, "We either hang together or hang alone". 2. Creating a single risk pool means we will merge the medical portion of worker's compensation into Medicare, saving American business significant revenue. Workers comp premiums in construction, heavy industry, and agriculture can run over 50% of payroll. Individuals will see significant savings when the single risk pool covers the medical portion of auto, home, and liability policies. 3. Merging Medicaid into Medicare means government will never require people remain paupers for medical care, an ill-advised social policy that keeps 55% of the adults in over 80% of the young children in Merced County where I live in poverty. We still have time to get it right.
9
@Keith very clear and convincing. People do not seem to understand that the medical industrial complex bills out 'x' amount of money each year. They will provide the same services no matter WHO pays, thus saying 'our country cannot afford it' is illogical. Someone pays NOW because emergency room do not turn down anyone. Not as clear and concise as your comment, but I hope you understand what I mean.
3
@Don Saelzler Absolutely.
1
I think Elizabeth Warren was pressured to come up with numbers because the other candidates didn't have any realistic numbers and needed Elizabeth Warren's sensible input. At least we all can have confidence Warren's numbers are a possiblity; not a soundbite.
7
Professor Krugman, I would love to hear you comment on the shadowy, under recognized "Chargemaster" that manipulates our costs and its place in the healthcare debate. Will it be eliminated? I would imagine so. Won’t this appreciably reduce costs with zero effort by anyone? Please give us your perspective.
3
Remember when Americans stood up in droves against the attempts under Trump to undo "Obama care?" There was perhaps no single idea which garnered more civic response. I think the focus in this primary on taking down Elizabeth Warren for this position is misplaced. Once again, Democrats are focused on preventing criticism from the Right.
6
Two considerations that have been rattling around in my head for years:
With Medicare for all, a whole cadre of white-collar workers in the insurance business will be out of jobs or suddenly working for the government. Can you imagine the outcry? If you think coal miners get angry!
And doctors and healthcare workers will likely have to have their compensation renegotiated—certainly not upward.
I’m concerned because I have already had the experience of looking for a doctor when my own retired, only to find how many practitioners don’t accept Medicare patients because they aren’t lucrative enough.
6
Even if her numbers are accurate, the complexity of the financing will baffle the average Trump supporter who will only hear "SOCIALISM."
2
Government exists to enhance the lives of its citizens, in my opinion, and the United States fails in this pursuit. We CAN provide free college and healthcare for all. As long as the wealthiest among us hold the reins of government, how can this happen? It's not in their interest. And Medicare isn't free. The government takes more than $100/month out of my benefits for Medicare, and I pay another $100 a month for a Medigap plan. I can't work because a doctor prescribed a drug that damaged my heart. By the time doctors figured out what caused the damage, too much time had passed and I could not collect damages. Medicare isn't free and it could be better, otherwise I wouldn't need a supplement plan. Things aren't going to change for the better until the ancien regime dies out and a new contingent of Alexandria Ocasio-Cortez clones take charge, which will, unfortunately, probably be too late for me.
4
The only number that counts is that 60 Senate votes are needed to implement her plan. It isn't going to happen.
So Klobuchar is right, this is a pipe dream, not a plan.
I would like to see universal, quality, affordable healthcare. However, Warren is not going to get us there.
4
@Biji Basi, wrong. Have you forgotten about budget reconciliation? All the elements that qualify under reconciliation can pass with 50 votes + the VP.
3
@Biji Basi Of course it isn't going to happen right away, even if Warren wins. But she is the only one really pushing hard towards decent health care for all. Which of the other candidates is truly planning for something better than the current system? Smart aleck remarks like the pipe dream crack (and I actually like Amy!) don't really help.
Who IS going rto get us there?!
2
@Biji Basi that’s what reactionaries (repubs) said about Medicare and ACA.
2
Are there accurate figures available that detail just how much is spent on health care in this country now? How else can we assess the alternative plans like Warren's that would be offered? Do we know what total expenditures are on OTC and other non prescribed procedures by the general public? Any plan to work will entail a necessary bureaucracy. How will that compare to the bureaucratic and profit costs of private insurance? It is hard to assess 20 trillions of dollars when we don't know how many trillions are being spent now.
@John Warnock So you will continue to spend way too much for your healthcare, and get mediocre care for that money. How much do you stipulate about cost from your private insurer? Can you even parse the billing of a surgery or broken bone or even a minor procedure? No, you can't, so why not try something different that you at least will have a say on? You sure don't have any say about how the system is run now, and insurance, hospital companies, and big pharma love you for not noticing.
2
@JP As a responsible voter I like to have facts available in order to support a candidate whose proposals I can support. My comment is not a criticism of anyone's proposal to date. As far as not "having a say on", my vote is "my say" and it does matter and will be cast in each and every election.
How will Warren deal with the perverse incentives and unfairness her plan creates? If she bases employer contributions on what they currently spend on health insurance, or on what they spend just before the new law is effective, the most generous employers will pay the biggest bills, but their employees' coverage will be the same as everyone else's -- and almost certainly inferior to what they would have received under their private plans. The public option is the way to go. But if we must go to compulsory medicare for all, let's at least make sure the taxes that pay for it have some rational connection to the ability to pay and the benefits obtained by those covered -- not penalize corporations that have actually been good to their employees.
4
@Chris So on further review her plan says employer payments will gradually converge toward a national average. That helps but still leaves the unfair disparity in place for as long as it takes for the payments to converge. This is still not the best idea, either as a matter of policy or politically.
Let’s not forget that Medicare is not free. I’m not talking about taxes. I’m talking about premiums. I am retired and I pay about $1,400 a year for Medicare out of my Social Security payment. No one mentions this. All the discussions I have seen seem to think that “Medicare for All” will be free. I’d love to see someone clarify this.
7
@Publius Yes indeed. There are Part B premiums plus mostly 20% co-pays. Not free at all.
3
@Publius the current bill is NOT existing Medicare. It's called "enhanced and improved" for a reason. (Of course, it may not be the bill that's in play in 2021.) https://www.congress.gov/bill/115th-congress/house-bill/676
I agree with Krugman. Medicare for all my be affordable, but not politically viable. To that I would add a question: if medicare for all does pass, what happens to all the people working at private health insurers?
4
I agree that there seems to be a tremendous amount of thought put into this series of ideas. I have doubts about it working but I do admire the ideas. But I think that this will not help her chances to become our next president. Just the fear of having the government run the entire healthcare system is enough to scare the support out of me. My state cant even run the DMV in a way that works well. I would still vote for her because I understand that this plan will never become reality but, there are far more that do not understand that and that is a problem.
2
I think you left out of Elizabeth Warren's plan the tax on stock trades.
If she wins, and that's a heavy lift and she'll need the senate, she'll have to enact all the things you mention to get Medicare for all up and running.
3
One big issue I see is that people want everything be done right at first try. If you have good blueprints you can adjust and tweak it. Also people need to realize that there is no silver bullet. Republicans implemented trickle up economy and it killing middle class. So start taxing 1%.
13
Ummm... Mr. Krugman, this is a Paul Ryan plan with magical thinking and asterisks and if he or any other Republican produced something so fundamentally dishonest you would call them out on it.
And here, when we need people who know this stuff to have their feet firmly planted in reality, Warren has put out a dishonest funding plan at a time when if we lose this election... well, the world is depending on us making the right choice.
There is no way that Warren or Sanders can win in 2020 with this approach. Republicans will tear it apart--and they won't have to lie--and the media will tell the truth about it as well.
The result will be disaster.
4
@OrchardWriting
I agree with everything. Except the part about the media telling the truth about. That will never happen. They will whitewash it and do whatever they can to achieve their own political agenda. I would challenge the NYT to tell the truth about it.
I am glad Warren's plan checks out with Prof. Krugman, even if he can't bring himself to support it. Ultimately Medicare For All is or should be the goal, whether we get there now or later. I look forward to seeing how Sen. Warren defends her plan against the inevitable attacks from Biden, Buttigieg and Klobuchar in the next debate. Will she acknowledge political reality that MFA is a big lift (or a "stretch goal" as my former employer would say) and she would consider a public option!? Or will she stick with MFA as her goal? Stay tuned.
1
Another approach is to publicly finance certain sectors of preventive care.
1. health knowledge. some of our citizens have very little understanding of how to take care of themselves. An educational program on public media and in public schools would help a lot.
2. Family planning and birth control. Every child is precious and every child is expensive medically, socially and economically. Families bear a huge burden and sometimes this burden is offloaded onto the public. Economically stressed, sleep-deprived
parents can lose their cool: with each other and with their children. Substance abuse, divorce, neglect, and abuse are
unfortunately too common and require huge expenditures from all governmental levels.
Paying for free family planning and birth control might actually be cheaper than paying for the consequences of unplanned children.
3. Insist that schools receiving public funds absolutely protect children's brains. We really can't completely fix a traumatic brain injury. Football? Heading in soccer? maybe not.
4. And maybe we shouldn't pay for infertility treatments.
4
A gradual transition to MFAll seems the most reasonable to most people.
I don't think Warren can win with her present program . We are a society that likes choice.
Too many forces against Warren. Modify or lose.
1
I'd like to agree with Krugman, but I can't.
Punting all of the consumer costs of the healthcare program to a wealth tax is almost voodoo economics--it isn't going to happen. Warren decided that her previous ambiguous statement about no cost increase to the middle class had been (rather dishonestly) positioned by the press as no tax increase. So she was caught and had to make that happen.
The result was a piece of nonsense that at least wouldn't be branded as reneging on the deal.
5
@jerryg, read the article. "Punting" the costs to the wealth tax is NOT the plan.
1
@John D. That's included in what Krugman describes as further taxes on businesses and large fortunes.
I think all the nay-sayers on Medicare for All should look back at the state of medical insurance back when Medicare for the elderly was first implemented. In 1966 only 60% of people over 65 had health insurance, as older adults generally had to pay around three times the cost as younger people for private health insurance. With a Democratically controlled Congress and a Democrat in the White House (LBJ), it passed as an addendum to the Social Security Act. The key to funding such programs, in my opinion, lies is twofold:
1. Raise the Social Security taxable ceiling above its current ~ $132K. That ceiling should be raised at least two fold with current median incomes around $60K, and the top 1% making at minimum $250K. Roughly 6% now have incomes above the taxable maximum, compared to 2.5% in 1937. In the post-WW2 years from 1945 to 1975, arguably when the U.S. economy was at its height, less than 1% of the population made over the salary cap. If the current 1-percenters make over $250K, the salary cap should be raised to match that figure if we are to return SS/Medicare to its post-WW2 financial integrity. 99% of the population should pay SS/Medicare taxes at the full level.
2. Income taxes in general should be returned to their levels from 1945-1975 for the wealthy. Since the mid-80s under Reagan, tax cuts for the wealthy and corporations of been de rigueur, producing the fiduciary deficits common today.
The wealthy should pay similar rates as the rest of us.
11
When Medicare (and Medicaid) came out they didn’t replace anything they became another entitlement but her plan replaces everything. When British NHS came out it was the first coverage many people had so it wasn’t revolutionary.
Her plan is a leap too far with too many unreal assumptions (just like GOP tax cuts) and too many loopholes.
4
@William C Vaughan As a Democrat, no one is really arguing with the state of the current system or even that a single payer plan is evil.
We just know for absolute fact that running on it in a national election in 2020 is political suicide and that's not a mission I want to go on.
This is the point of contention: Can Warren or Sanders win on a plan that spends $35 trillion--this is the actual cost--and will raise taxes on everybody--her assumptions are magical to the point of dishonesty--that takes employer provided insurance from 200 million people?
Looking at all available evidence: No.
And yet, we won in 2018 with a very pragmatic center-left approach and won, by a lot. Why abandon that with so much at stake?
1
@William C Vaughan
You make 2 very good points. The first point in particular, is a reminder we should try to uphold the SPIRIT of the law - and update it accordingly. Another example that comes to mind are the gasoline taxes (most in cents/gallon) that overall have not kept up with inflation since their creation, and thus of course will not be sufficient to cover much needed infrastructure maintenance.
We live with two competing ideologies: Capitalism says people will work harder, innovate more, and be more frugal when they have a financial incentive, and so they produce more value in the marketplace. Socialism says that we the people can produce more value through democratically-elected government operations that eliminate the vast profits taken by corporations and investors in the marketplace.
Let's let these two ideologies face off for about ten years and let the marketplace determine which one works better in the health care arena. Make MFA available but let people keep their private insurance if they like it. (Sound familiar?)
Eventually, either MFA or private insurance will become the favorite and the other will die out. Or possibly, like energy providers and a few other enterprises, some mix of the two will win out. This could be Warren's path to keeping the faith with MFA while doing less to frighten political moderates.
1
Men have lost their lives unable to afford insulin, people are going bankrupt because of medical bills, and I don’t know how long I can continue paying $1600 a month in premiums and deductibles. Those claiming we cannot do this, need to understand, we have to do this. I just spoke to a guy at a party - a small business owner with ten employees - when I commented on our recent increase, he offered he had to come up with $18K each month to pay for his and his employees. This is insanity. And for all of those premiums, all of those years, my husband had his knee replaced a year ago, in a remodeled strip mall, where by lunchtime he was released to a hotel room where I monitored his vitals and kept his knee iced, following a strict regimen of pain medicine, anti-coagulants, and anti-inflammatory s. As they local dentist told him, “You have a great nurse!” The bill was in the $100K range, excluding the hotel stay. Talk about corruption!
9
@rebecca1048 Again, mandated Medicare is not the only solution to the problems you list, that I have lived and agree are real.
But it is the one solution that guarantees we will lose the election. Meanwhile, plans put out by other candidates more closely follow what the Europeans do and are very popular politically.
So if there isn't one of none for solutions, why die on this hill that will not have a chance of passing anyway.
We can solve the problems and win the election.
2
I think he was trying to placate the tradmongers that got him elected. He heard us, that we didn't like Biden much, so he tried to go that route.
I'm sorry Trump, but I don't agree with breaking the law. You might have done it for us, nevertheless, don't break the law!
I like the Medicare for all proposals, but!
Realistically I think we need to start with the following;
1. Repair the gas lighting destruction to many of the supports to the ACA. It's amazing it still functions as well as it does, but would perform much better if the GOP injected bacillus was removed.
2. Simply include the working poor in the gap between Medicaid and Obamacare eligible on the ACA marketplace sites with 100% subsidy, thus doing an end run around their stupidly destructive policy of not expanding Medicaid in the states.
3. Increase subsidies all around.
4. Provide a robust public option.
3
@Chris Morris Not only is this approach very, very workable and a far more elegant solution to the problem, but it will help us win the election.
Mandated Medicare will cost us the election up and down the ballot. It will be a complete electoral disaster for all Democrats.
1
Now that Warrren has produced her detailed plan, the ball is now in Mayor Pete's court.
Where is the detailed plan analysis of his Medicare for All (* who want it) plan?
He can also explain why Health Insurance companies, and Pharma industry are financing to his campaign.
And why he is accepting their 'help' in formulating his plan.
4
When your supporters reassure others about your centerpiece policy by saying "Don't worry, it will never happen," you might want to rethink your message. You might want to recognize that our existing laws and our thoughts about justice are being decimated daily.
4
As usual, Paul Krugman gets it all wrong .
Warren’s completely untenable social engineering plan in the guise of a preposterous Medicare For All , is disingenuous pandering to the left .
7
Another way Medicare for All will lower costs — getting rid of the hidden “facility fees” that hospitals and “surgi-centers” and “cancer treatment centers” and “infusion centers” add on when you go to the doctor FOR ANYTHING.
These are the scams that make Americans pay DOUBLE compared to Europe, Canada and Japan.
7
It appears that few have actually read Warren's plan. Most comments do identify cost as the main healthcare concern, unlike 2008 when access was the primary issue. The ACA did expand access, but failed to address the cost issue. Warren's getting to the cost drivers of health care (provider payment arrangements, insurance administration, pharmaceuticals etc.) The real genius in Warren's plan is the political insight. Warren campaigns as the leader of a grassroots movement for big structural changes. Her MFA is politically viable. It includes: employee raises (no more deductions for health insurance premiums; benefits that include longterm care coverage (hear that baby boomers?); no deductibles and co-pays; and no health savings accounts (more raises). Most importantly, an end to bankruptcies due to healthcare costs. These are all very real issues to voters. The polls show the number one issue among voters is health care - the cost of health care. Now let's see how, or if, her opponents can respond. The political insight she has shown in rolling out this plan should inspire confidence in her supporters that she can in fact mobilize the grassroots movement that will be necessary to drive and sustain big structural changes.
7
She dreams impossible dreams. Not sure how realistic her plan.
Free healthcare , free childcare, free college. All are very exciting. Free not Necessarily means it is all good!
3
@peter I think free healthcare is possible if people really want to do it. IRS definitely need to go after rich and collect money. With all loop holes they pay nothing and middle class gets punished. I do not agree that colleges needs to be free or child care.
1
@peter I don't think "medicare for all" means "Free". More like affordable even if it is incorporated into the tax system.
1
Medicare for all who want it will lead to a win, and those who choose it winding up better off than those who don't. In five years, that eventuality will result in Medicare administrating the nation's health care system for 2% instead of the private insurance sectors' 18% and up.
3
Krugman admits Warren's plan is not likely to see the light of day any time soon. That is not just too bad, it is evidence of ideological rigidity on her part and an indifference to reality.
2
Uninsured rates are rising along with premiums. Even if 80-90% of Americans are covered I would not bet that they are happy with their insurance, as they are paying more each year for less coverage.
Reducing drug costs is a start, but there are no controls on insurance company profits, which are surging. As long as these companies continue to exist, they will be a drain on administrative resources, which of course will raise costs.
Public option is the cowardly way out. This is just another insurance company, which those with private insurance will have no interest in funding while they are trying to pay for own ever-worsening coverage. If every person was in the same pool, it would be less complicated, as well as more efficient, to balance overall costs and acquire funding.
3
I want universal health care. I don't want medicare for all and a system with no room for private supplementary insurance and choice. I am not a medical scientist but as someone who finds it necessary to keep abreast of developments in medical science, I know that a system that denies me certain choices cannot deliver the care I expect. The Canadian system doesn't; I know it first hand and the British system doesn't either. The French Dutch and Swiss systems do and the fact that private insurance plays a role has something to do with it.
2
Seldom do I agree with everything Paul Krugman says on a subject, but he is absolutely right about Elizabeth Warren, whom I originally opposed for rejecting out of hand a public-option-type plan. She will still have to make that compromise eventually, but as Paul Krugman points out, Warren is coming up with some innovative -- but very sensible -- thinking.
11
"The wonder is not how well the bear dances, but that it dances at all."
I'm not enthusiastic about several features of Warren's plan, nor about the specific numbers she throws out. But it is a -plan-, not just arm-waving. Haven't seen anything nearly as credible from any other candidate. And the GOP? "Die quickly" is hardly a plan.
12
You desperately wanted to be able to support Warren but found yourself restrained because she wasn’t bailing on MedicareForAll sufficiently to suit you .
No you’re back because you think she’s bluffing and will ultimately settle for a top down , corporate centered buy in that opens the door for private health insurance companies to effectively privatize Medicare . That’s certainly their long term goal .
The wisest , most fiscally responsible and humane approach to addressing our national healthcare crisis is to expand one of our most successful social welfare programs ever to cover all. Any other avenue caters to corporate Democrats and the GOP. They will never serve the public interest nor deliver care to the most needy and powerless among us .
I salute Elizabeth Warren for holding firm on MedicareForAll. The more the merrier in that lane as far as I’m concerned . However I still prefer Bernie’s plan as well as his steadfast conviction to see it through . If he can’t do it , nobody can .
4
@Paul G Knox Nobody can.
It's an incredible amount of money, so where does that leave President Warren in taking on a $1T deficit and all the rest of her plans, such as college? Would there be anything left to tax after Medicare for All?
3
@Boomer
Please remind us again what we got out of trump's 0.984 trillion dollar deficit?
https://www.washingtonpost.com/business/2019/10/25/us-deficit-hit-billion-marking-nearly-percent-increase-during-trump-era/
While I respect what Ms. Warren is trying to do -- unburden people from untenable out of pocket health care expenses, I think that Medicare for all supporters misunderstand the basic problem. Sadly, a lot of insurance, including Medicare, is pseudo insurance. People pay so much for their medical care that the insurance has failed its primary mission: to protect from the catastrophic expenses of being ill.
However, Medicare for all (MFA) doesn't solve the real problem: the cost of inputs into the system regardless of who pays for it. Unless this is addressed any solution will be too expensive. An extraordinary amount of this "cost" is essentially money from insurance funds being diverted to investors, the most obvious being investors in pharmaceutical companies. However, it also includes suppliers of medical devices (artificial hips, heart valves), reagents and supplies for medical laboratories, software for medical offices ... the list goes on. These investors include shareholders in large pharmaceutical companies, including pension funds, university endowments and owners of 401K accounts (i.e ordinary people), as well as private stake owners such as owners of radiology facilities.
All encounter large insurance funds, public and private, to which goods and services can be effectively ransomed, raising both the cost of insurance (premiums) as well as the costs to sick people who need to use the insurance.
MFA is political comfort food, evading the real problem.
The part about "closing tax loopholes" is a loophole in the plan. Many a time it has been tried, to not much success.
The continuation of "employer contribution" is obvious. Intellectually it can be attacked as a stealth tax, added into the price of companies' goods/services. But rather than shift it directly onto individuals where the pain would be obvious, best to leave the thing as such the way it is. We have become comfortably numb to it (that hidden "tax").
Besides, when Biden attacks Bernie for only paying for half of his plan with taxes...well, the employer bit is, like with Warren, the other half.
Medicare level payments will be hard to sell in the long run.
The plan no one seems to want to embrace is pretty easy and straightforward- remove Medicare (& SS, though not related) caps. There is some dedicated cash). The better off have been getting away with paying a lesser % for too long anyways...
2
False - massive savings with no demonstrable track record of government programs running efficiently, massive taxes on businesses and individuals. We will need medicaid with the recession this program will create
@Chris
"Medicare Has Lower Administrative Costs Than Private Plans. According to the Kaiser Family Foundation, administrative costs in Medicare are only about 2 percent of operating expenditures. Defenders of the insurance industry estimate administrative costs as 17 percent of revenue."
1
Friends in Peru, and in Mexico, tell me that medical care is excellent and available to all. Don't have details or direct experience myself but I have no reason to doubt them.
In the US Republicans cry 'SOCIALISM' and many are frightened of that word without knowing what it really means. Mo Brooks, of Alabama, says, and it is a Republican mantra, "if you get sick, it's your own damn fault". Then Karma gives him cancer.
Society clearly benefits when health care is treated as a necessity, and a right. The GOP does not view 'society' as a reality in any sense though. They abide by the Thatcherism that states that "there is no so called society, just a large group of individuals": Either rise to or be born at the top or give it up.
Warren attempts to bring us together with her 'plans' and the GOP is frightened that we will listen and act.
17
@Harold I moved to France 2 years ago and am now on their health care system (ranked #1 in the world). Also, my son and his family lived in Sweden for 16 years. I've observed both sides: there is a good reason that NO other modern democracy uses the 'for profit' model of the USA and that ALL of them have some form of 'socialized' or universal medical care. It's more efficient, covers everyone, costs about half (or less), and allows for more 'research and development' instead of sending profits into the pockets of wealthy investors, executives. In fact, the next time your doctor suggests a new medicine or technique--ask 'where was it developed?' Chances are it won't be the USA. However, the major problem will be wresting control from the huge and powerful health insurance companies.
8
"Am I enthusiastically endorsing this plan? No. I still think that a public-option-type plan, which lets people buy into Medicare, would have a better chance of actually becoming reality . . . ." Krugman
The question isn't whether Warren offers a good plan, whether other countries have such plans, or whether Warren's plan is financially viable (it is). The question is whether the majority of Americans will vote for MFA. They won't, as a simple matter of fact. They will vote for a public option. And so the question is: how will Warren move to the center on this issue?
3
@Wiltontraveler
How do we know that the public will not vote for MFA?
5
@Jean
The insurance industry will spend millions bombarding the air waves decrying SOCIALISM.
1
@Jean Opinion polls on this subject are numerous: https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-october-2019/; https://thehill.com/hilltv/what-americas-thinking/428958-poll-voters-want-the-government-to-provide-healthcare-for;
All of the polls I've read say the same thing: Americans are about divided on MFA, but large numbers (around 70+%) support a public option.
As Daniel Burnham famously said, "Make no little plans; they have no magic to stir men's blood." Elizabeth Warren has made a big plan, as why bother with anything less? Will all aspects of it be realized? Certainly not all at once. But it will surely move the needle toward a universal health care system that all can afford and all can access, just like Obamacare did. We'll get there one day if we keep the goal in our sights.
And is Warren's health care plan any more audacious than candidate Trump's promise that if he became president, every one was going to be covered and it was going to be cheaper? Of course, that's about as detailed as he got, health care being so complicated and all.
15
@Citizen-of-the-World
Perfect!
I was with the same employer for 40 years. I chose that employer's most expensive plan and was able to see any doctor without networks or referrals. Now I am on a pricey Medicare plan that does pretty much the same thing.
But the transition, involving all kinds of research into the unknowns of a seemingly endless array of options, was time consuming and anxiety producing.
If I were still with my old employer, and told I had to switch to an unknown plan, I would have been unhappy. And I believe a sufficient number of like minded people might lead to a win for the megalomaniac over Warren.
I hope she has a plan for that!
3
@Tennis Fan
And you find no ethical problem in choosing a more expensive plan, buying better access? I think it is a crime against humanity!
1
@Tennis Fan
Medicare and Social Security are the two best plans around. Medicare premiums no way get close to private insurance coverage, you can keep your doctor, it is portable if you change jobs or move to another part of the country and if you have a pre-existing condition before you were eligible for Medicare, that too is covered.. This system is already designed. It is a roadmap for MFA.
I am in disagreement regarding that people will not be able to have private insurers if they wish. That is the only part I disagree with. But it would not take much to convince people when they compare what they o
pay to private insurers versus what they pay for MFA I bet most people will opt in. As will Corporations, as they stand to pay less for Health insurance than they do right now.
1
@rebecca1048
What ethical problem are you talking about exactly. What crime against humanity? Are you being facetious? I think you would have to explain that one a little better. You can’t just invent moral or ethical scruples because it might make you feel superior. Or are you implying that buying a more expensive Medicare plan that covers more is somehow quasi-illegal like hiring an undocumented nanny and not paying their social security taxes? I really can’t fathom.
I'm glad she started the conversation about HOW we will spend our money, and on what. Of course, I believe we should spend our capital on the things that will help all Americans, not just some. Her words are not cast in stone, and there are many details to be added and ironed out. But, for the life of me, I can't figure out why M4A is so hard to clearly explain, and why it's so hard for average people to understand. Apparently, the right words have not yet been found. This is a simple issue, and the solution is just as simple. Maybe some actually CHOOSE to misunderstand. Personally, I'm very interested in saving thousands of dollars while receiving better, more complete service.
17
What Warren has not addressed to my satisfaction is the massive disruption that will occur in the existing health insurance industry. Mind you, I'm not a fan of the existing industry, and absolutely want some kind of single-payer system, but I don't see how instantly throwing God knows how many well paid people out of their jobs is going to help matters.
All Warren has said that I'm aware of is that the people in question will be absorbed by other aspects of the insurance industry, such as auto and home. Those jobs are already filled, so I don't see it.
I think Warren would make a wonderful president, but she has to demonstrate the ability to change her mind instead of doubling down on an idea that is too obviously vulnerable to attack.
4
@Vesuviano Agree. But I think the response would be to phase in these changes. A public option within the Affordable Care structure would be a place to start.
8
@cjg
To the best of my knowledge, Warren has never said her plan would be phased in. In my view, she has further explaining to do or her plan will become her albatross.
@Vesuviano Maybe these people could be retrained as nurses, clinicians, intake personnel, etc. Universal health care will open up many, many jobs, because we're going to need more people to provide more health care. I'd be willing to bet that most rank-and-file people in the insurance business didn't have pushing paper as an ultimate career aspiration -- it's a job -- so wouldn't it be nice for them to actually help the sick and infirm instead of just processing endless forms and/or looking for ways to cheat customers out of the coverage they've paid premiums for.
3
Senator Warren, why would 90 percent of Americans give up their insurance for the unknown.
We need a plan that covers the 10 percent, Public option with subsidies for low income Americans is a doable answer.
Not will it cover the 10 percent it provides an alternative to private insurance
We need to reduce costs, HR 3 being marked up by the House is a major step forward this will reduce Prescription Drug prices for all. Part of the savings can be used for subsidizing the Public option.
We can do this now not in the distant future
We know the cost of ourHealth Care system is not sustainable.
Politicians, lobbyist are incapable of coming up with a plan.
Let’s have an expert commission to look at the way forward benchmarking other systems, eg Germany which has twice as many Doctors and Hospital beds per capita than we do
1
@Carsafrica So you think 90% of Americans have insurance that's paid for by their employers? 90%? Ninety per cent? I think you're wrong. I've heard that only 40% of workers do, but I could be wrong. Throwing around misleading statistics seems like a Republican tactic...
9
@Ray Clark
I got my numbers from the Census Bureau.
Private Insurance covers about 67 percent, the other 33 percent covered by Medicare m Medicaid , VA etc. So you are wrong as for inferring it’s a Republican tactic, tut , tut,
I want to help the 10 percent now , we can do that with a Subsidized Public Option.
For the record I am a pragmatic Democrat I want to get things done and not be mired in the bog of
wishful thinking.
I have experienced Universal Health Care in 3 different countries , each was different in process coverage , cost. We can learn from all
1
The PPACA is working well and costs are coming down.
Why become Socialists now?
Makes no sense to me, a lifelong Democrat and OBAMA supporter! Go JOE!!!!
2
That’s not necessarily true. My ACA plan went up $200 a month for 2020.
9
@Arcturus My ACA plan went up significantly as well.
The question is why, and who is pocketing this extra money.
The increase was ~20% over last year.
Inflation may account for 1.7%, but where is the rest of the money going to?
Are they paying doctors more? I don't think so.
My guess is that this is going straight into the profits of Insurance executives, political campaigns, and lobbying efforts to defeat M4A.
5
“To dream the impossible dream” Warren has come up with the perfect formula for certain defeat. I want to get rid of trump, but this will hand the election to the republicans. No way will this plan happen for reasons far to many to list here. She has painted her party in a corner and doesn’t know how to get out. 21.5 trillion over 10 years will really sound good to the regular American! Sad, very sad!
2
It can't possibly be serious if it probably won't happen. Surely the definition of serious in this context means realistic. Politicians are always promoting things they can't possible pay for, and never do they name the trade-offs - whose ox will be gored to make something happen.
1
All proposals by candidates are just that. Even if advanced once the person is president, it will have to go through several committees, the sure resistance of the opposition party, the deadly influence of lobbyists. What we can get from candidates' promises is the "direction" of their policies. What we can expect is small movement, a timid first step, toward their goal. However small, it's better than a step backward from the other side.
4
@Frank Casa
I get direction. That’s what your voting for when you choose a candidate. But when a candidate proposes something so preposterous, so devoid of the real world, the next question is, why would I choose this person to run the country? This person clearly doesn’t know what they are doing.
Case in point, she makes MFA a cornerstone of her campaign, but never thought about how it would be paid for. After a lot of pressure, she had to hire people to come ok with a plan to pay for it.
Seriously, who does that?
Teenagers maybe?
1
@NYCSurgical Sometimes a person has to be outrageous just to get others to pay attention and start considering new ideas. It took decades for women to 'get the vote' after some bizarre actions (such as hunger strikes) before their rights were taken seriously. The Civil Rights Act took years of marches and protests, 'un-civil' discussions, murders, before it was passed. Many patriotic people who were against the Vietnam War were vilified, even murdered, because of their opposition to that unjust war. At least she and Bernie S. are making people consider options and discuss ideas.
1
@NYCSurgical
Just a second. A candidate who will deal, when president, with a myriad issues: from farming to diplomacy, from health to defense, from immigration to the economy, is going to hire knowledgeable people to develop his/her program. Unless you are a genius like Trump who knows more than generals, more than international experts, etc.
Getting experts in the field to flesh out your ideas is precisely what a leader should do.
2
Go Liz!!! Please add small business opportunity to the soup.
As a Brit I was born and raised on the NHS for 25 years before being face with the American system or lack-there-of.
When I stared my first business I was confront with getting:
A) Clients
B) Working space
C) Employees
D) Healthcare
I could NOT afford healthcare for myself and ended up with $10,000 hospital bill.
I was able to keep the business going for ten more years
Can you image how many business start-up have either failed or not happened be the cost of healthcare.
Here is looking forward to President Warren!!!
23
@Clive
This is a crucial argument that Liz and Bernie have to start making clearly because it ironically undermines the naysaying position of supposedly pro-business conservatives and non-Trumpian conservatives.
Medicare for all is pro-business (except for the health insurance industry) and makes US companies more internationally competitive. Oh, and it makes our people healthier too, which is sort of a nice thing for a nation to be able to say.
All our elected officials have great health plans. So they know how valuable it is.
Why can they not agree that it is beyond the time when ALL Americans should have this.
Are we not a civilized people? We are the only first world country to not have this.
It is absolutely disgusting that so many self processed Christians would be against good reasonably priced health care for all.
8
Okay. This is a serious issue, and I am glad that Krugman, who generally knows what he is talking about, is convinced.
As for me single-payer, private insurance, options to buy into national health but those who can afford it pay for private insurance on top of it (as they do in Britain); the last seems the most viable. Everyone has a right to health care, as we all have a right to education, driving on safe highways and bridges, and being protected (in the best of all possible worlds) by a police force we all pay for. (It's a working model: people who can afford it and want to do so send their children to private schools,, but their taxes support the schools in their communities; those who can take private helicopters do but the rest of us take the subway, which is supported by taxpayer dollars; people who want to have their own security details, but they still pay for our community police forces! Etc.)
But--Warren, right now, is the only viable candidate in the primary. Biden and Sanders are both trailing. The only thing that is important--and I repeat, THE ONLY THING--is that Democratics and sane people in other parties, if there are any left, get behind her NOW, stop giving talking points to Republicans, and unite to beat Trump in the upcoming election.
Otherwise, with all this scholastic back and forth, and pedantry, WE WILL LOSE THE ELECTION, Democrats will have shot themselves not in the foot but in the head.
12
@Concerned Mother
Krugman is an economist. I use that term lightly when it comes to him. He doesn’t know a thing about healthcare delivery. He never worked in the field. He doesn’t get his info from hospital execs or doctors. It’s all generalities he gets from the internet.
Bottom line, he doesn’t know what he’s talking about. And neither does Warren.
No history or experience in healthcare, yet they want to change the entire system.
Think about it, why are you getting your information from folks who never spent a day in the field?
2
@NYCSurgical
We are not looking for medical advice..
we are just trying to figure out how to pay for it.
5
@NYCSurgical
Irrespective of Krugman being an Economist, he does know what he is talking about,. He, like most other people, do their research before they write about it. Even some politicians do this.
Don't you research when you have a problem in order to solve it?
1
Yes, she's working the problem but in the wrong direction. Insisting on taking private insurance away form those of us who worked for that coverage shows us two things about Elizabeth. One, she doesn't see the forest for the trees (Protecting our constitution and democracy requires being electable); Two, she can't see the forest for the trees (it is now clear that she isn't capable of compromise).
1
With the exception of Switzerland, we pay more than double what other developed countries pay for healthcare. Other countries have systems that cover everyone. We are paying $10,000 per person.
I do not understand why this is ignored by Dr Krugman.
Granted it would be a multi-year effort, but if everybody else is doing it why can't we? Why should reform require an increase in costs?
I really would like Dr Krugman's thoughts on this.
6
Don't expect comparable spending on healthcare to other countries, because this proposal is for reforming insurance. Healthcare is going to be a much bigger effort, which will require reforming tort laws and other influences that caus doctors to perform defensive medicine. Also, we have to come to grips with our addiction to overuse of the latest technology.
And then there are the salaries. My spouse spent 13 years after high school training to be a radiologist, at a huge cost, and many years of modest salary. The equitable transition to lower pay for doctors will require careful legislation and a long execution, unless we want to see affordable insurance for healthcare no one wants to provide.
3
@Robert
Walk into a hospital in your neighborhood whose phones population is mostly private insurance, not a poor Medicaid Neighborhood.
Have a conversation with a surgeon, and a hospital exec.
Then take a plane to Switzerland and walk into one of their govt run hospitals.
Let me help you out and paint a picture, and save you some time.
It’s the difference between walking into NYU and waking into your local DMV. Not just the looks of the building, but the staff too.
1
@NYCSurgical I'd take Switzerland any day of the week over US health care. Americans should be so lucky! I have been mis-diagnosed, had 2 hospitalizations due to 'doctor errors,' had doctors not listen, paid for what turned out to be unnecessary dental work, and on-top-of-it-all waited 5 years for an MD to -finally- accept me as a new patient, driving 50 miles when seeing my previous doctor. [Re: my local DMV - I made appointments and was in and out in less than 20 minutes.] The current US health care system is a mess and most realize it has to change!
2
Once the wealthy are on the hook to pay for it, rather than solely profiting from it, healthcare costs will certainly drop precipitously. This needs to happen, sooner the better.
11
Medicare for all would have been a great idea if it had been implemented 40 years ago, before Reagan came up with HMOs and the current administrative nightmare of the health care insurance industry developed. But until Warren and Sanders explain how they plan to replace the millions of jobs that industry provides (although admittedly expensive and budensome) would be replaced and the whole industry dismantled without crashing our economy, I can't support it.
Instead, let's add a public option to Obamacare so folks can buy into Medicare if they choose and allow a gradual transition to a largely (or even entirely) public, low-cost system.
3
@kr
Not bold enough. Its time for systemic change - after all the same doctors and nurses will still be practicing medicine.
Bernie's plan would phase in over 4 years so the changes wouldn't be an overnight revolution. Besides, killing jobs to improve efficiency is what this country has been about since the 80's.
2
@kr
So, I'm supposed to continue paying $10k/year for a plan that has a $7,800 out-of-pocket maximum so, some people can keep their jobs. On the same theme, we should continue to spend 3/4 of a trillion dollars on the bloated military in order to keep those jobs, too? And then we should listen when critics say the richest country in the world can't afford universal health care, something that all other developed countries have and plenty of not-so-well developed one, too. Not to mention not being able to afford to educate all our kids or fix our roads and bridges, because we've got to keep buying billion dollar bombers.
Seriously, dude?
13
@kr the devil I'd in the details. A public option alongside private insurance could really result in insurers dropping their older, sicker customers, forcing them onto ther public option. That would make the public option very costly. And what if people don't have health insurance and can't afford ther public option? Without safeguards in place, the public option collapses. Why can't the can- do US do what every other developed country does and assure healthcare to its citizens?
3
Paul, you really "think she has met that challenge"?!? What about "the challenge" of beating Donald Trump? What about "the challenge" of appealing to voters who aren't Bernie supporters? You AND Warren need to get out of your deep blue bubbles & talk to voters who want to keep their current private plans at least for now. Warren has made some truly outlandish promises over the last few months. I honestly thought she was smarter than that but I think she's been in Cambridge for far too long.
She doesn't have the slightest idea of how to run in OK or TX, the states where she spent the formative years of her life, much less PA, MI, WI & OH, states where union workers DO like their private insurance plans!
2
@Elizabeth
I think you only want to keep your plan because you're change can be intimidating.
Nobody really 'likes' their insurance. You may use it and be satisfied with it, but its ridiculously overpriced compared to all other western nations and the system bankrupts 500,000+ every year while making $100 BILLION profit for the insurance industry (which goes to executives and shareholders).
Do you think you can go out on a limb and vote for something that will save you money overall AND pinch the billionaires out of some of their money?
3
This is a distraction at a time we don't need distractions. It took both Houses and a President to barely drag Obamacare over the line. Great vision but wrong time.
7
@Steve
Obamacare wasn't a vision. Medicare-for-all is a vision.
Obamacare was a bastardized compromise born out of Obama's vain attempt to elicit nonexistent Republican support when he killed the public option.
The most important issue in America today is getting money - especially corporate money out of politics.
Not defeating Donald Trump.
You replace Donald Trump with some middling flip-flopping democrat who is deeply in debt to the billionaires who fund their campaigns (looking at you Buttigieg and Biden) we will be back the situation that lead to Trump in the first place.
There has never been any doubt that a formula exists to finance it but an election isn't a math test and "it probably won't happen" is a gross understatement.
1
I'll never forget the woman in Boston who had her thigh stripped of skin along with some underlying tissue when her leg dropped down between the pedestrian platform and a slow moving subway train. As bystanders whipped out their cell phones to call 911, she screamed, pleading with them not to call an ambulance because she couldn't afford it. Or, the young man - just over 27 years old and no longer covered under his parent's insurance plan, who died of diabetic shock because he could no longer afford the cost of his insulin medication that had just increased 10 fold. Many people are dying or living with terrible injury and pain because we think empathy is for suckers, until we become sick or injured.
18
At least Warren has a plan for universal health care! The Republicans health care plan is drop dead! I am more supportive of Senator Warren because she has the courage and smarts to be a great president!
12
I’m no Nobel prize winning economist or political analyst but I’m reasonably sure warrens plans will give us 4 more years of trump. God help us.
5
@Vivien Hessel
Couldn't agree more. Trump is king of the one-liners and name-calling that would no-doubt resonate at least somewhat with the undecided or those not into delving deep into politics (disinterest, unable to allocate the time/thought process needed for understanding, etc.). I shudder to think what effect "Crooked Hillary" and "Lock Her Up" had on the outcome of the election, but I'd bet it was certainly enough. If it takes Dr. Krugman to explain if her policy makes sense, the policy is doomed and subject to devastating criticism by Trump one-liners.
I'm afraid many of her other policies would fall victim to the same litmus test--if it sounds hard to understand/believe or sounds like major change (we've had more than enough of that over the past 3 years), she will have little chance to try out her policies. Same goes to the other Dem. candidates--keep it simple and recognize the advantages of proposing a significant but incremental/logical implementation or extension of common sense. I think many undecided or "independent" voters are understandably tired of Trump upsetting the apple cart and seeing the unpleasant/totally foreseeable consequences.
On a separate but related topic: be VERY careful about how to provide health care to undocumented immigrants--I think if done too willy-nilly (e.g., advocating full benefits for any medical condition as soon as setting foot in the US), THAT might be a bridge too far for a critical group of voters.
1
Has anyone actually read the Medicare For All bill? Here is a link https://www.congress.gov/bill/116th-congress/house-bill/1384/text which may work if cleared by the Times. If not, it is easy to find if you search for it. The entire bill is worth the time it takes to read, but Section 107 is of particular interest. Although we hear that the plan takes private insurance out of the equation, it's quite cleat that there is still a role for private insurance, and the reason is simple: Medicare does not cover everything. Also, contrary to popular belief, Medicare is not free.
As an enrollee in traditional Medicare, I think it's great. But I still have a private Supplement Plan to cover the twenty percent of my medical expenses that Medicare does not cover. This bill may eliminate that twenty percent gap; it seems to say that. But I wouldn't bet the farm without more discussion on the specifics.
You may support Medicare For All, or you may oppose it. But you should be conversant in its provisions. We need to take this discussion up a notch and get into the nuts and bolts of a plan that promises to alter the healthcare landscape for everyone.
10
@K M
Its very likely that after President Sanders forces through Medicare-for-all there will be corporate entities that offer supplemental insurance to their employees with provisions for elective surgery, etc. that medicare wouldn't cover. Private insurance won't completely go away - but the resulting savings from going single-payer will lead the country to never go back.
The dirty secret of medicare for all is that its a huge tax cut for businesses no longer under any obligation to provide medical care to their employees.
Medicare-for-all, having capital gains taxed at the same rate as ordinary income and and 10% corporate tax hike among businesses earning more than $100M/year are just the things America needs right now.
@D W Three fairly significant assumptions in your opening sentence: How will, #1, President Sanders, #2, force Mitch McConnell to do anything? and, #3, that everyone is an employee of a 'corporate entity'. I'm still pretty sure you haven't read the bill.
Perhaps, if the candidates themselves won't get into the specifics of the costs and provisions of Medicare For All, we can expect NYT to do a practical analysis.
By the way, taxing capital gains at the rate of ordinary income will affect virtually everyone's retirement investment income. Nothing is easy.
Yes, Warren's plan is serious because she is a serious person with a better than average brain. Unfortunately, most politicians in both parties are not as serious as her, which is why Prof. Krugman is correct in predicting that Medicare for All probably will not happen. It's too sensible for people who aren't.
9
Yes...how about “Medicare for all who want it.” As the pool of people who keep private insurance drops, premiums and co-pays will rise, and soon everyone will opt for buying into Medicare. Presto! M4A...but with far more complex growing pains.
Politicians have, forever, advocated for more than might seem possible. At the very least, it communicates in no uncertain terms the direction they want to help push the country in. Thank you Elizabeth Warren.
4
@Mike Pod
I think it should be Medicare ADVANTAGE for all.
Stressing that one think would be a way to give people the “choice” they crave. Plans C through M seems like lots of choices.
2
Paul the numbers just don't add up.
5
Paul Krugman has hit the nail on the head. Medicare for all would probably work but a better solution, that would please and assure many Americans, is a strengthening of the ACA. That was an excellent beginning within the parameters of American Healthcare. A return to the original plan, before the Republicans bludgeoned it to death, would be a good start. This would also maintain the powerful Health Insurance Companies, the Democratic Congress, who wrote the Act, astutely brought them into the deliberations.
It is crucial to the survival of our nation to allow citizens access to healthcare, healthy citizens are a win-win.
2
While many people say they are satisfied with their health care plan, I'm not sure everyone distinguishes between their insurance plan and the actual health care they receive from MDs and other providers. Presumably, under a Medicare-for-all plan, there would be a single insurer (the federal government), while people's choice of providers would increase, including not only their current providers but also those who are out-of-network under their present insurance plans. This is a point that is easily lost, and Sen. Warren should emphasize it.
Another problem that a single-payer plan would solve is the sheer number of plans now available, a consequence of Republicans' endless attempts to privatize Medicare. I recently received my annual Medicare manual. In addition to old-fashioned Medicare, it lists over 90 (!!) wrap-around and supplemental Medicare plans available in New York City, where I live. Most are offered by large insurers: Aetna, Blue Cross, Humana, United, etc. Each insurer offers multiple plans, creating this variety by adjusting the plans' key variables: premiums, deductibles, copays, and benefits. How any human being can sort through so many plans and make sense of them is beyond me.
Finally, I wonder if Warren's plan allows providers to opt out, as they can now, and operate on a straight fee-for-service basis. None of my long-time MDs, save one, still takes Medicare, and I may eventually have to start doctor shopping, which at my age (81) I'm loath to do.
5
America won't accept so large a number, no matter what the return on it might be. The pricetag will scare off too many voters, I think.
2
Not, when compare with how much we pay for healthcare now
2
What her plan does not address is how to overcome relentless sabotage from the Right.
The more perfect the plan, the greater the threat to those who insist that government is the enemy. Woe be unto those who try to prove them wrong!
7
Her plan is seriously, seriously flawed. The net worth of the nation has historically ranged between 5 to 6 times GDP, putting today's net worth at about $120 trillion. Warren's plan has proposed cost of $52 trillion - she wants to consume nearly half the nation's net worth on health care.
She cannot raise taxes enough to come anywhere close to paying for a $52 trillion plan. Taxes would absolutely rise on the middle class too. This plan is not serious. In fact, it's awful.
9
How about rising premiums, deductibles and decrease coverage under today's system? How much we pay for today's system including everything: premiums, deductibles,out of pocket expenses? And that number is bound to grow every year, how that is not tax on the middle class?
3
@yulia Premiums & deductibles are not a tax. They are expenses for insurance and health care services. We tax income in America and if one does not work, one does not pay income tax. But that person can still face health care expenses.
The math just does not add up. Medicare is less than a decade from insolvency now and she wants to saddle it with $50 trillion more in obligations and consume half the nation's net worth to get there? The math does not work.
2
@Once From Rome I don't care if it is not tax, I still have to pay it, and even if I don't work I still have to pay the expenses as you say, and if I don't all my premiums were paid in vain, even if I paid for 20 years and didn't use the service. That's why the system of premiums is so bad, and should be replaced by taxes, that will correlate with your income and you are guaranteed the healthcare when you need it, independently of your ability to pay. Moreover, the private insurances drives expenses up for everybody, including people on Medicare, because the insurances don't have negotiation power and don't want to fight when they can raise premiums and deductibles to recover their loses. Medicare for all will be much more stable than Medicare now, because it will increase the pool of people (right now only old people are in Medicare, making it very high-risk pool with a lot of care), it is broaden the financial base, and it gives the Government very strong negotiation power that will bring spending under control
1
There are two main impediments to Warren's health care plan; the first is an ideological and paranoid fear of "socialized" medicine. (Other than some very rich people and corporations making s spiff off of the health care industry that results in the U.S. paying at least 5.5% more of GDP more than any other developed country there is no reason for this difference.)
The second is that those vested in the current way of health care delivery are going to be scared blue that they will lose their business model making vampiric profits at the expense of people's health.
As a people, you have to learn not to be frightened of the word "social", and you have to stand up for your basic right to health care - a right that exists in every other developed country. Do that, and support it up an down the ticket, and you will get what the rest of us have - affordable good health care.
I am a Canadian. We have a good but imperfect health care system, and we live longer, will lower morbidity, at a lower cost. You can have this as well, but you have to be willing to support it.
But then, maybe you prefer medical bankruptcy, and insulin rationing over a system that has the s-word as part of what it is.
24
@Nicholas
Canadians are satisfied with their health care system only because the US functions as a 'relief valve', enabling those with the means to travel south for care a la carte. Not quite the definition of single payer, is it?
Also, the vast majority of the pharmaceuticals are researched and developed in the US - the singular reason is the profit motive. Would you prefer the government decide which diseases to cure?
A command and control economy (socialist/communist) can never function as efficiently as the rational consumer acting in his best interest.
1
I think this plan has the seeds of the next frontier for our healthcare system. However, with more immediacy and really urgency, what about the US’s infrastructure: power grids, internet access (fiber or lack thereof), power supplies, highways, etc. A new WPA,if you will, that put money into the economy with measurable outcomes, may be the first step forward to our future.
9
Assuming that Democrats win the White House and Congress remains divided, Democrats will have an opportunity to work in an open way that will persuade the public that Medicare for All is the best option.
First the House and the Warren Administration should flesh out the Warren plan with additional details about providing care and financing the plan. The fleshed out plan should be posted on the House website and Committees should be tasked with drafting the legislation needed to make M4A a reality.
Second, a the House should designate a Democratic member in each state to hold a series of town hall meetings in each state to receive citizen input on the bill. These meetings should be held during a four week recess.
Third, if citizen input indicates a need for revision, the plan should be revised and individual citizens should be publicly commended for their suggestions.
Fourth, the bills needed to implement the M4A plan should be introduced, committee hearings held and the bill passed by the House. If the M4A Bill reflects the will of voters, the Republican Senate won't be able to resist President Warren's demand for action.
The worst result would be for Democrats to draft the legislation behind the scenes with little or no direct citizen participation while wealthy individual and corporate donors have a seat at the table. The ACA suffered because it avoided the direct citizen input needed get voters onboard.
2
@OldBoatMan
I detect perhaps false optimism re : "If the M4A Bill reflects the will of voters, the Republican Senate won't be able to resist President Warren's demand for action."
Can't seem to forget all the folks that tried to derail Obamacare for so long (& in many ways succeeded), and the gloomy prospects for a Republican Senate & curbing the power of The Tortoise to scuttle EVERYTHING during most if not all of the term of the next president.
2
@Erasmus Polling consistently shows that voters want universal access to healthcare. The thing Democrats should focus on is involving voters at the grassroots level.
That never happened with the ACA. Congress and the Obama basically created a plan that every insurance company could love. It was kluge care.
When the Republicans came out against the ACA because of its "death panels", many believed the Republicans because the public had no idea what the plan contained.
When the ACA took effect, voters were somewhere between underwhelmed and turned-off. We can't afford to let that happen again.
IMO, the answer is to involve voters early in the process, be candid and keep voters informed of changes and compromises. That will garner more voter support.
For most people with insurance the real objection to Medicare-for-all isn’t economic, it’s social. They’re afraid that the masses of uninsured currently flooding the nation’s ERs will instead be taking up space in doctor’s offices, preventing any chance of getting an appointment in a reasonable amount of time.
1
@Robert Schwartz
Have you been to an ER lately? Its already like that.
So what is next proposal from the socialist wing of the democratic party? Single payer journalism owned by the Federal government? How about having a single automotive company ran by the EPA where cars are given to everyone via an employer tax system? Or perhaps the airline industry becomes owned and operated by the FAA? After all everyone should be able to fly as a basic human right. My attempt at tongue in cheek discussion is that having the federal government in control of our healthcare choices and payments is a slippery slope towards a economy dominated by government ownership. Not sure how this is efficient given the performance of the VA and postal service. But perhaps the American people are fine with the expansion of the federal government into our lives. However it sounds Orwellian to me and counter to the welfare of a free and open society.
8
Why not apples to apples comparing Medicare for all to... actual Medicare, instead of other, unrelated programs? And, why not accuracy about the role of government? Medicare for all is about coverage and payment, not about controlling which doctors people can see.
6
Slippery for what? We have Medicare already, we have Social Security ran by the Government. We have public schools that also provided by Government. All this didn't translate in the Government control over manufacturing or journalism, why M4A will?
3
@Patricia the key is government controls the payment and the money and therefore controls the industry. Access to care will become the problem as reimbursement to Medicare rates for hospitals and doctors will likely lead to less doctors and longer wait times. In the plan proposed is a section outlining this approach. Access is now controlled and the results are government decides the care path. No thank you
1
Far be it from me to argue with Paul Krugman, BUT .. .
What does Warren's plan assume for MFA payments to hospitals and doctors? Currently, Medicare pays something around half of the "list" price for hospital stays and doctor visits. Hospitals survive by charging everyone not on Medicare the higher price. To be sure, hospitals need to improve their efficiency, but such a large cut in payments would put some hospitals (smaller, rural) in serious jeopardy.
And second, we are already running trillion dollar annual deficits. Warren has proposed a number of revennue-raising ideas to (barely) pay for her multi-trillion-dollar-per-year MFA plan. That still leaves us with trillion dollar annual deficits for the foreseeable future. Why not enact the cheaper Medicare option plan and use that revenue to significantly reduce the deficit???
3
This may have already been addressed in the over 1,000 comments currently posted, but I see no mention of the current consumer premiums and co pays, their relationship to the pool of health care funds and how their elimination could mitigate any possible need for increased taxes.
I make no advocacy, here. Just curious as to how this factor figures in.
7
Warren talks a lot about taking on drug companies as part of lowering the cost of healthcare. Why does she say nothing about the enormous food lobby in this country that works so hard to ensure that people in the US do nothing but put unhealthy, processed, noxious food down our mouths leading to record rates of obesity, diabetes and heart disease?
I would think that if you want to really get at controlling the cost of healthcare you would want to tackle the overall health of the population. Should junk food be taxed? Should people who lead unhealthy lifestyles pay more into the system? Should companies like McDonalds and Coca Cola pay more?
Where’s your plan for that Liz? Until you address this aspect of the issue, you are not serious and have no chance of containing healthcare costs.
4
@Hmmm yes, by all means keep raising the bar. Move the goal posts. Change the subject. Demand more from Elizabeth Warren than you demand from any other candidate. And even after she's produced reams of bold and brilliant plans, declare that she's "not serious" — and unelectable.
Blatant double standards like these are what keep women from running and winning.
5
@Hmmm Taxing unhealthy food? Would you also endorse subsidizing farmers who grow healthy vegetables and the food chain that follows that food to markets in low income communities? Because if you are taxing Kraft mac and cheese, you need to provide something affordable to those who rely on it to survive.
When spinach and free-range chicken cost the price of Kraft mac and cheese, then let's talk about taxes on food that is not healthy. Otherwise, you are just continuing the decades of making the poor poorer and less healthy.
We all could eat healthier, if we could afford to. And, we could all exercise more if our city neighborhoods and parks were always safe places to walk, run or play. And, if none of us had to work three jobs to afford our powdered mac and cheese and some of our prescription medicine for our pre-existing conditions.
If a President Warren wants to fix all that, I hope you will be with her when she needs to put money into that plan.
1
I am wondering how other countries managed to bring the health cost down while not taxing the food, you deem unhealthy.
1
Some of the points Paul left out which is eye opening for an “economic master”. Hospitals cannot survive by only taking Medicaid or Medicare. The private plans pay out more which lets this model survive. You simply cannot put a gun to doctors and specialists heads and say you must take this. So she’s going to have to explain what she would do if say doctors and hospitals started coop healthcare options. She’s going to have to explain when all top doctors decide to not take insurance. Also how will she explain rationed care? Just because your sick doesn’t mean everything is covered by Medicare or Medicaid. And lastly what this effect will have on small business already struggling to survive? Did this plan take into account our diabetes and autoimmune epidemics and the projections that as this number grows that we will go broke quickly? Does it realistically price in chronic illness that are preventable? The more costs shifted on the backs of employers guarantees less minorities starting small businesses due to cash flow and upstart costs. If you want to stop the Amazon’s of the world the market needs to be easier for those with dreams to start companies regardless of their backgrounds. If anything employers need to be taken out of the healthcare game entirely. This is not wise nor will I vote for this. Paul is correct with a buying in option but he’s wrong not to bring up these other extremely relevant issues which will cost the Dems the election.
3
The problem that keeps getting overlooked is that Medicare reimbursements only cover 75-80% of the cost of care. Hospitals and clinics make it up by charging those with private insurance 120-125% of their cost of care. If we all go on Medicare, our health care system as its currently structured goes bust. In other countries with single payer, they control all aspects; how many hospitals and clinics can be built, salaries for doctors and nurses, what equipment they're allowed to own, who gets a single room, what drugs are allowed,... We don't have anything like that, and it would take a lot of restructuring to get there without significant increases in Medicare reimbursements and taxes. This is not mentioned in any Democrat plan because it means either a much higher cost or mass closings of medical facilities and pay restructuring (cuts) for all medical employees.
4
@Steve yup Paul is an economic master yet leaves out these well known details. The Nursing Union is not going to stand for the reimbursement reductions it would take to make this happen. Sanders plan had a 40percent pay reduction.
2
@Steve Respectfully, cost-shifting is probably overestimated as a meaningful phenomenon. See https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160596/
It is intuitively attractive but not necessarily as large an issue as has been commonly accepted.
@Steve
Hospitals Emergency rooms are also required to provide service without regard to ability to pay. In many cases, the reimbursements is 0%. I'm sure they would rather be reimbursed 75-80%, than 0%.
With M4A, this cost will be eliminated, and ER's will again be used for emergencies. This may end up being a net gain for hospitals.
2
Why are so many people still conflating single payer, i.e., MFA with universal coverage? We could have universal coverage, which should be the goal, without MFA. Most countries use a combination of public and private, with cost controls. If we want to model ourselves on the majority of the developed world, we will take that route. The single minded pursuit of single payer makes no sense to me.
6
Employers may not save much money with this plan. It obliges them to pay premium money into the single-payer system rather than to United Health Care or Blue Cross or whomever.
But it's still a huge savings. Business people presently spend lots of frustrating time trying to organize health plans that serve their workers AND avoid bankruptcy. (I've done it.) A scheme that takes away that time-tax on business leaders can be a big win.
And, Medicare, as a payer of hospitals and doctors, is well known to work well at scale. Medicare For All can use the skills in the Medicare system, rather than having to invent and debug all-new payment schemes.
On the other hand, the present system in the USA employs a lot of people in more-or-less decent white collar jobs. Single payer will throw lots of people out of work. What's the transition plan for them?
6
What I like most about Warren is that she understands the relationship between capitalism and democracy is broken and requires a major overhaul. What she must overcome is the growing belief that government is too corrupt and dysfunctional to be of use to average Americans. Republicans have done their best over the years to foster this belief. That’s part of the reason many people fear loss of private insurance despite its high cost and inefficiency. Given the way Republicans have played games with people's lives by constantly threatening Obamacare, the fear is justified. To make her plan a possibility, we must first accomplish the even more difficult task of restoring confidence in government.
13
I own a small business and provide health insurance, very good health insurance to my employees. This plan creates a huge incentive for me to drop my employees from their plans before Warren takes office. Me and my partner are Medicare eligible today but only take part A because our plan covers everything else.
My employees would be better off if I gave them a small raise and bought a private plan now and went on Medicare for all when it passes.
Putting out a plan like this is likely to lead to fewer insured people before a new plan goes into effect. I'm very disappointed that a democrat would put out a plan that before it becomes law will lead to fewer people being insured.
3
@HL
I feel sorry for your employees if you are so easily tempted to drop their health coverage. This points out how tenuous health coverage is for employees.
But I'm sure they will all feel exceedingly grateful by your 'small raise', while you travel in your private plane.
1
Rest assured that preventing you from slipping through the cracks has already been considered. I’m sure Sen. Warren has a plan for that.
Sen. Warren issues a detailed plan, and immediately gets attacked by gophers nibbling at her ankles. Let's not forget: The Republicans have NO plan. The cost of health care in the USA has to be part of the 2020 campaign. Too much of GDP goes to health care without commensurate results for that investment. The costs simply have to come down. Only the Federal government has the institutional power to represent all the people against the medical, pharma and insurance industries. Yes, they are industries. We also need to get employers out of the health insurance business. This is not their job. So, the Warren plan represents steps in the right direction to bring costs down, level the playing field, and get better health care results.
31
Paul, thank you for this. I completely agree with everything you’ve said here. As trump was the antithesis of Obama, Warren is that to trump in spades. Smart, serious, honest, ethical and most of all truly confident. I do hope Warren compromises on MFA and goes with the public option also. It’s just too much political capital that we need to spend on climate change.
16
If I vote for Warren, it will because that no one else is preferable but Barak Obama is the the gold standard for this election. I think it makes no sense to do a Medicare for all because it ignores what the electorate wants. In the long run universal health care is inevitable because insurance siphon wealth. Once, each state had a Blue Cross and they were not for profit but the Republicans turned those into a business and a constituency.
5
Here we are throwing "more taxes" stones at a healthcare plan the likes of which most developed countries have adopted and achieved LOWER costs with. The GOP scare tactic always seems to work. What about the truly scary facts of having lousy or no healthcare?
Warren's plan is attacked for "raising taxes" while the GOP plan... Oh, wait, WHAT GOP plan? There is none. What happened to that "beautiful" plan Trump promised in the days when Ryan and McConnell were "repealing" Obamacare? If it ever existed at all, it got swept aside by the push for the 2017 tax bill that REALLY lowered taxes for the wealthy - and a barely there tweak for the middle class, just enough to say "lower". The GOP flashes the shiny TAXES flag to distract but then never delivers better healthcare for the middle class. So what is the default healthcare plan for the GOP? - a pared back, hidden under the rug Obamacare!
It is time to throw rocks at Trump and the GOP for not delivering that "beautiful" (or any) plan.
17
Last night a commentator pointed out the plan's significant cut in doctor reimbursement rates. I suspect there are cuts to other health care providers - or would be if Warren's plan ever becomes law.
If so, one of the most fundamental laws of economics comes into play. If you force the price of something below the market-clearing level you get less of it. If doctors get paid so little that they can't cover their own costs, or can't make a living commensurate with their lengthy education and stressful work, fewer people will become doctors and more doctors will retire early or perhaps go to law school.
The end result is health care rationing, something which is endemic to social-democrat economies. (If I had a nickel for every conversation with a European who complained about the miserable care received by an elderly parent...)
2
There it is, the health care boogeyman: rationing. The problem is that everything is already rationed according to price. The question isn’t whether Warren’s plan will lead to rationing. The question is whether the rationing Warren proposes is fairer and more efficient than any other plan now on the table. Are we better off in this particular case when there is an open and democratically directed rationing scheme than when we let the invisible hand do the rationing.
5
@HurryHarry
If I may say so one the (few) successes in both the Soviet and Cuban political systems was the universal health care they provided to their peoples. One of the results of their policies was the proliferation of women doctors. I believe this was so because, whereas women (it may be argued) are more apt to become doctors out of a motivation to heal men in our capitalist society are motivated primarily to get rich. One can make a lot of money by becoming a doctor in the US. If universal medical care means fewer doctors to profit over a sick person's misery so be it. The continued good health of a nation's people should be a prime concern of any nation's governors for economic reasons as much as for humane reasons. (Persons becoming approved for Disability Assistance before they are even old enough to vote is a disgrace in this country.) I suggest that persons wishing to become physicians should not have to pay for their medical educations. As for America's pharmaceutical "industries" - perhaps shame is the only remedy. God knows there is much they should be ashamed of.
@HurryHarry
If I had nickel for every time an American complained about high insurance premiums, co-pays and deductbles, or the annual reselection of a policy, or the endless arguments with providers and insurers over billing codes, or the inability to find a practioner who's in plan, or the general rudeness of the American for-profit healthcare scam, or the stories I read every day about medically induced bankruptcy. What a great system. Well dobe, America!
1
It’s important to note that hospitals and physicians would all have to accept Medicare rates of payment which are significantly lower than rates paid by commercial insurers. That’s not a deal breaker to this physician but it’s intellectually dishonest to not acknowledge that fact. Some lost revenue would be offset by lower administrative costs for billing and higher reimbursement for Medicaid populations, but not all of it. Let’s go into these discussions with eyes wide open and all the pieces of the puzzle on the table.
16
I started reading the comments to this piece and I became very disgusted at our close-minded approach to this problem. So many other countries in the world have provided universal medical care to their citizens. We should be ashamed that we can't even discuss this and come up with a solution to this problem. The cost we pay for medical care in this country is ridiculously high and a burden upon our economy. Sanders and Warren are proposing plans that will address this, yet, so many are unwilling to discuss it even out of the gates. The tiny country of Costa Rica, of which I am very familiar, has universal healthcare for everyone and has provided it for decades. The difference between that tiny country and ours, is that in spite of our Christian chest-beating, we really don't care about our fellow citizens. We don't prioritize our health, child care, and other things that other nations have found to be the nuts and bolts of a good society. We would rather toss around terms like socialism and communism without actually knowing what they mean, and simultaneously listen to some who proclaim themselves as pro-life, while their citizens die from lack of healthcare. We are indeed a conundrum and our ignorance, as well as our obstinacy, will destroy us. We can indeed fund the world's greatest killing machine, yet we cannot find the means to provide life-saving medical service for everyone at a reasonable cost.
31
@Kjensen
If the ACA legislation had been implemented as written and as intended (with each state being forced to develop an exchange and/or expand Medicaid) we would be very close to universal access to coverage right now.
Getting that far was almost impossible so what on earth makes you believe Congress would ever pass THIS plan, which really and truly is "socialized medicine" with coverage for undocumented immigrants to boot?!?
Get real.
1
@Kjensen THANK YOU for this comment! Spot on!!! Having grown up in a country with universal healthcare (which paid for my cancer treatment at age 25 with absolutely NO cost to myself and my family) and then spent the last 30 years living and working in the US, I am experiencing first-hand how inefficient, needlessly complicated, grossly expensive, and chaotic the US “system” is. Not to mention the scaremongering from the right, where “social” has become a dirty word, and anything remotely useful to the common good is called “communist” by default! I wish I could recommend your comment as required reading nationwide! AMERICANS, WAKE UP TO REALITY!
2
@Kjensen And another elephant in the budget room: defense spending. Costa Rica -- as far as I know -- has no nuclear arsenal, no bombers, no F-35's, no air craft carriers, no military installations around the world, and isn't at war with fanatics in multiple countries.
(And, full disclosure: I prefer Mayor Pete's plan to EW's.)
1
OK, so now she has a plan. This plan will wrench away insurance that many are happy with, even if complaints are the order of the day, or month, or year. So, she is substituting her "esteemed knowledge" for the will of the people. Government, by its nature is unwieldy and difficult to navigate. This is not a good plan, and, should she become the nominee, will hand the election to t.
4
@Tom What’s more important here is that she will throw the White House back to trump for another 4 years.
I am a democrat, and a physician, and generally have always enjoyed and usually agreed with your takes. But even if you were ok with what this plan would do to reimbursements not only to doctors like myself, some of whom may retire early at a time we have a national doctor shortage, but millions of health care professionals (and many hospitals barely in the black even now, and the many in the health insurance industry who would lose their job), this plan is full of accounting gimmicks. Relying on the overseas contingency defense fund is as much of a gimmick when used for health care as when applied to the military. To bank on a large magical swath of money from immigration reform that has yet to even be proposed let alone get through a senate with Mitch McConnell is not realistic. And she is still at least 10 billion dollars short on a plan that I think is largely unworkable, has little chance of getting through even a dem Congress, but a high chance of making sure this time trump not only wins but gets the popular vote as well.
5
@Rakesh Shah
Amen!
ENDING THE STRANGLEHOLD OF HEALTH CARE COSTS ON AMERICAN FAMILIES
https://elizabethwarren.com/plans/paying-for-m4a
10
Around Thanksgiving at the end of this month, eight Heavenly bodies will nearly align. Earth, Jupiter, Saturn, Mars, Venus, Mercury, The New Moon, and the Sun, will all be within a few degrees of a straight line through the Sun with a combined gravitational influence more than usual. The nations of the World should prepare for potential Earthquakes and Tidal events. Perhaps the nations of the world will see this event as a message that the fragile world is easily destroyed and should begin making military's obsolete, Nuclear weapons banned, and resources expended on a new age of sincere diplomacy. For 79 years, the world would not believe a war of utter destruction was possible. It is possible as our military leaders somehow coerced our President Obama to approve rebuilding the nuclear arsenal despite he having made efforts at eliminating them and was rewarded with the Alfred Nobel Peace prize. Our nation must curtail the Beast that is the C.I.A. that creates enemies, and the military that maintains it's empire by fighting wars. A war lasting 18 years and a war in Iraq that was wrong is a wake up call to our nation to either render them mute or abandon the nation in light of an inevitable outcome because of them. For 75 years, our nation has existed building the weapons of mass destruction that terrorized us as well as the world. War is easy and will reside here eventually unless the braver peacemakers take hold of the military empire and chain it as they have chained us.
2
Even that "Trumps" Health care concerns, unless you wish to finance iodine tablets.
Beware the Gods of War.
In a much anticipated celestial event, Mercury, the messenger of the God's, will transit in front of our Sun on Veterans Day, next week, November 11, 2019.
Beware the Messages of the Military.
Beware the "Ideas" of March.
You’re so predictable.
1
The takeaway from the comments section appears to be this:
Meet halfway and start bargaining from there. Any good negotiator should know this is a recipe for failure. Start from a position of what is right and don't negotiate until the time comes to do so.
You couldn't design a worse system than the one we have now even if you tried.
Raise your hand if you get dividend checks from your health care related investments. Not many hands I see, but those that do are seeing huge gains. Why on earth should a system pay out huge profits to investors when those profits are based on the denial of care to those who need it and over-prescribing of medications and procedures to those who don't?
23
@Johnny
You won't get the chance to "start from a position of what is right" if you don't beat Trump!
And based on the outlandish promises she has made over the last 10 months, Warren has no chance of beating Trump right now because he will label her a "socialist" and for once, he will be right!
1
@Johnny If trump wins there won’t be any medical care, social security, Medicare and warrens plan will still be the pipe dream it is now.
Universal HC? Contrast is a good eye opener.
See NYT video/article/comments-- “How Europeans See America”.
Quote:
“We asked young, ordinary Europeans to take a look at U.S. policies on everything from food to guns. As they discover facts about America, they’re not impressed.”
Europeans are shocked to learn that the American government does not guarantee social protections that citizens in other advanced economies take for granted.
Their reactions reflect how European governments prioritize citizen welfare, offering national assurances like universal health care and affordable education.
Americans have grown accustomed to the exorbitant costs of basic human services, the absence of parental leave protection and the unregulated presence of chemicals in food — things that would “cause riots” in Europe.”
1450 readers commented on this, many very interesting by people who have lived abroad.
It was just a short video—we need more. This contrast should be front and center, used by our media and candidates to enhance and widen our debates. We need reality---not Reality TV politicians.
What works in advanced capitalist countries is deemed unworkable here---by the powers that be. This has long put many of our progressives on the defensive. Some are pushing back, but it's not easy in our political culture.
At least the Times saw fit to give readers this unusual video.
19
@Meredith Most of the previous generation in Europe basically made a pact with their governments. A higher tax for lifelong protections. Americans have never contemplated such a pact and at least half of them still won’t.
1
This plan would have a chance of succeeding if people like you, informed educated people who acknowledge that it's a good plan, would get on board and stop towing the GOP "how you gonna pay for it without middle class tax hikes" line. Let's stop acting as if every single government program doesn't cost money. Taxpayer money. That's how the government is funded. It's not some dirty little secret. As a member of the middle class, I'm perfectly OK with a tax hike if that's what it takes to implement this. In fact, I'd like to see the savings that could be realized by dissolving the VA healthcare system and letting Vets access the same system we all do. Their needs aren't different from the general population and the cost of maintaining is significant. And let's stop promoting this GOP fantasy that there are legions of people so desperately in love with their insurance company that they'd riot in the streets if forced to go on Medicare. Find me just one person who, on turning 65 says "Oh no! Keep that socialist Medicare abomination! I'm going to go on sending $700 or $800 a month to my beloved insurance co." Medicare for all needn't be the end of private insurance. It will just end it's dominance. People could buy supplemental policies if they wanted. But everyone would have comprehensive medical coverage under Medicare, funded by all taxpayers. Please tell me what's wrong with that?? Why are you overthinking this?
31
@A. Cleary So let’s add another 30 trill to the current gigantic hole in the deficit that trump has given us. Because as president, warren will not be able to do a single thing until she fixes that trump mess
Our greatest medical misfortune in the U.S. may be our persistent refusal to acknowledge the obvious.
By a significant margin, we have the highest per capita health care costs among all advanced nations while our national health outcomes have remained mediocre for many years.
Other nations' more efficient health care programs are not military secrets.
Are we incapable of learning from them?
If so, why?
Have we been infected with a deliberately cultivated stupid germ?
And wouldn't that account for a number of other obvious questions?
19
@Kirk Bready your "infected with a stupid germ" is hilarious metaphor, but hits the nail on the head. " Willfully ignorant ", or to paraphrase Will Rogers: " I only know what I read in the papers" ...and hear on Hannity/FOX works too. Well what the heck, the President says we're "human scum " if we don't agree...
If you think that grandiose, pie in the sky plan on how to fund this "passes the test" you need to go back to high school math and economics classes. And where does she even address the 3 million people it puts out of work?
2
@bored critic
May I suggest that the 3 million put out of work were working in jobs that should not have even existed in the first place. They must be retrained for meaningful employment elsewhere. Private health insurance industries are parasites and I look forward to their demise. There is no justification for their continued existence. I would be happy to pay higher taxes for universal health care. What do I get for my taxes now?
Trump's security while he plays golf instead of attending to the nation's business?
1
Warren put a stake in the ground to start discussing the specifics of Medicare for All. No, her plan won't get by Congress as-is. But the discussion has to be started at some point, and hers does that. Now the debate can happen about which parts of the plan are feasible and which aren't, and that is by far more substantive than anything the Republicans have come forward with, or ever will. The main risk is that the details of her plan are complex enough to fly over the heads of most voters, who are left with partisan and inflammatory misstatements from the right that her plan is no more than a typical tax-and-spend $20 trillion leftist nightmare. It is very far from that.
10
No way she now gets elected, if she even wins the nomination. Bernie supporters got a mad- man elected, she may do the same.
7
How come Krugman doesn't mention that doctors and hospitals will - under the Warren plan - be paid at Medicare/Medicaid rates. What will THIS hammer mean to health care - the number of doctors, the numbers retiring or not entering the profession, the hospitals that fail financially? He doesn't say this is a BIG hole in her plan, as it blows her financial projections out of the water even while it trashes the medical profession.
6
@Paul : There are numerous ways to get around this problem. First off, if you reduce the cost of a medical education, there would be less emphasis on the part of the physician to need to hustle to pay off the astronomical school loans that they accrued over the years of schooling and training. Make medical school and training first affordable, then draw your BEST students in order to produce bright intelligent but reasonable providers. In regards to the edifices we call hospitals, cut the perks like hotel style lobbies, flat screen televisions in every room, and concierge services. As a friend once said, she would rather see an intelligent doctor in a tent than a less proficient one in a palace.
11
@Paul ummm... and no mention that the payments to doctors and your hospital management costs are possibly part of the problem in US healthcare. Like big pharma, it may be that you're paying more for doctors and hospital management than the rest of the world...
6
@Paul Here's what I see when I drive around my area. I see hospitals adding new buildings to their campus. I see fancy new office complexes for medical groups. When I see that investment, I don't see financial failing, I see a sector that is thriving. Who is paying for these buildings? We are! So we must be paying too much for health care if there is so much cash flow for Dr. Smith Medical Group and Smith General Hospital to invest in new buildings.
4
If you, mr krugman, think this grandiose, pie in the sky plan passes the test you need to give back your nobel prize and go back to HS math and economics. And just where oh where is the discussion and impact of the 3 million insurance and HR industry people who will be put out of work or the effect of so called healthier people who will still retire at retirement age but live longer, therefore using the benefits longer without contributing? Oh, nobody thought of that one either.
Remember the phrase "voodoo economics"?
3
@bored critic
Voodoo economics is doing very well, thank you. It is a primary concern of the Republican Party.
Free healthcare and free college!? I want free beer and chicken too. So, all these unproductive people living in our society will suddenly have coverage? Seriously? On top of that, the very rich will somehow go along with this fantasy by way of higher taxes? How? The politicians in Washington are nothing more than a valet service for the rich. The middle class would be paying more in taxes, much more, if this fantasy was realized. Don't worry though because this unicorn saleswoman ain't gonna get it done.
This is all going to be accomplished somehow by a government in Washington that is divided and agrees on mostly nothing? The national security-warfare state has already chosen to spend our scarce dollars on wars and planning for the next wars. Sorry kids...this is why we can't have nice things. (caveat, I've voted only "democrat" for the last 50 years.)
2
I am very disappointed that my comment on Medicare- for -all did not get published. There is nothing uncivil in what I wrote. I gave the same opinion as one of today's columnists, namely, that Medicare for all is too far left, regardless of its merits, and will ensure that Trump gets re-elected. Neither Warren nor Sanders is electable, regardless of what New York Times readers choose to believe. Repeat after me: Michigan, Wisconsin, Pennsylvania. Also strive for Ohio, North Carolina, Iowa, and possibly Florida.
4
@ron l
I hate to say it but I agree with you. Anything "to far to the left" is anathema in this country. A pity this. The deplorable people in Trump's base are proof positive that many Americans willfully vote for what is not in their best interests. Are Americans ready for democracy?
Other than ACA, this country stopped making logical decisions long ago. Why start now?
2
I’m an expat currently living in the Middle East. Literally, today I will be going to the pharmacy to start stocking up on drugs for my return to the US. The drugs that I will buy here, which were invented in the US, will cost me about $0.10 on the dollar compared to a US pharmacy. I will need to stockpile about 2.5 years of drugs to get me to Medicare.
In many ways, this tells you all that you need to know about the American system.
It’s like an old horse. It’s time to take it out behind the barn, shoot it and put it out of its misery.
15
1. Phase it in over 8-10 years, starting with Medicare for All over 60, then Medicare for All over 55, and down the line.
2. Mandate “certificate of Need”. Madison, Wisconsin has 4 hospitals that perform heart surgery. Reduce it to 2 or 1. These would increase volume of heart surgery by concentrating it to less hospitals, with resultant cost savings. Medical studies show that hospitals that have higher volume of cases get better surgical results.
3. Close VA hospitals and clinics in large cities were the Vets can use civilian hospitals with their Medicare for All card.
4. In rural areas without hospitals that need them, build combined VA/NHS/Indian Health service hospitals and clinics to serve everyone in those communities.
5. Improve medical education so that doctors are more skilled and talented in treating patients.
“Skilled Medicare for All”. Every year I had to cancel my clinic of 20-30 patients between 20-30 times a year to travel a distance to the ER or hospital to care for patients with a simple nosebleed, who have been brought to the hospital by ambulance because no doctor within 60 miles felt “comfortable” with caring for a patient with a nosebleed. In the 1950’s every general practitioner doctor felt comfortable with these common emergencies. Nowadays the doctors spend most of their training typing and data entry on an electronic medical record EMR.
To be continued....
7
I think the point people are missing here is that M4A with a projected cost of 32-34 trillion, has been estimated at 4 times the entire cost of our defense budget of 7.886 trillion over the next decade.
The cost adds more than 50% to our 'total' federal spending over the next decade (currently projected at 57.845 trillion)
Would it be worth it in the long run - likely.
In the short run, however, such a massive program is a good way to terrify the independent voters in swing states and lose the general election.
And for what?
It is pointless to run on M4A when the buy-in to a medicare like public option has enormous support according to a Kaiser poll, is far less expensive - no sticker shock - and does the same thing !
https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/
https://www.cbo.gov/system/files/2019-08/55551-CBO-outlook-update_0.pdf
4
Unfortunately, when you step outside the progressive bubble, you realize that the radical changes Warren is calling for point(horrifyingly) to a 2nd term for Don the Con. There are many moderates, Independent and Republican, who will simply not vote for Warren. I know some very thoughtful anti-Trump Republicans who believe Warren is a gift to Trump (and would NOT vote for Warren). And her health care proposal doesn't pass the sniff test even for me (a lifelong liberal with moderate fiscal tendencies). Her #s don't add up. 1. She uses state Medicaid funding - but many states (such as GA, where I live) don't fully fund medicaid. 2. She assumes that the monies that businesses currently pay for employee health care benefits can be turned into a payroll tax that companies must pay to the Federal Government... not sure that is viable or how it will affect companies hiring decisions. 3. Warren pays Medicare rates for all services, payments that many hospitals say don't cover their costs. But...#4. the biggest issue is Warren's bottom line cost... 20.5 trillion. The #s attributed to Bernie's MFA plan is 30-32.6 trillion (per the Mercatus Center at George Mason University). Warren is assuming 12.1 trillion in savings through increased efficiencies? So what if Warren is wrong? How does she make up 5, 10, or even 12+ trillion? We have to give everyone coverage, but there are better ways! Not to mention that her other spending proposals are off the charts...
4
@CaptainPlanet When has any government prediction on cost been even remotely accurate? Ever? Name one.
Unfortunately, when you step outside the progressive bubble, you realize that the radical changes Warren is calling for point(horrifyingly) to a 2nd term for Don the Con. There are many moderates, Independent and Republican, who will simply not vote for Warren. I know some very thoughtful anti-Trump Republicans who believe Warren is a gift to Trump (and would NOT vote for Warren). And her health care proposal doesn't pass the sniff test even for me (a lifelong liberal with moderate fiscal tendencies). Her #s don't add up. 1. She uses state Medicaid funding - but many states (such as GA, where I live) don't fully fund medicaid. 2. She assumes that the monies that businesses currently pay for employee health care benefits can be turned into a payroll tax that companies must pay to the Federal Government... not sure that is viable or how it will affect companies hiring decisions. 3. Warren pays Medicare rates for all services, payments that many hospitals say don't cover their costs. But...#4. the biggest issue is Warren's bottom line cost... 20.5 trillion. The #s attributed to Bernie's MFA plan is 30-32.6 trillion (per the Mercatus Center at George Mason University). Warren is assuming 12.1 trillion in savings through increased efficiencies? So what if Warren is wrong? How does she make up 5, 10, or even 12+ trillion? We have to give everyone coverage, but there are better ways! Not to mention that her other spending proposals are off the charts...
2
The political problem for Warren is that few of the 150-160 million people who have private health insurance now are likely to want to exchange it for a novel, government-run, single payer scheme. In fact, they'll fear the unknown. Republicans are certain to capitalize on these fears by reminding voters about the technological problems that the healthcare.com website had in 2013 despite the millions of dollars spent on creating it. The GOP will ask "If government couldn't even get a website right, are we going to trust government to get an entire health care insurance payment system right. And, by the way, it's going to cost a lot more than Senator Warren says it will. "A number of those 150-160 million people with employer-based insurance will vote for Trump even if they dislike him because they aren't willing to exchange their known work benefits for a new program that might not work as planned. There will be no President Warren as Donald Trump will win reelection, an outcome that will further endanger American democracy and the rule of law. Universal health care will be available to those emigres who give up on the US and move to countries that already have it. It saddens me that Senator Warren and her team are so politically naive or stupid.
3
@UtahnYou say that few people who have private health insurance are likely to want to exchange it for a novel, government-run single payer scheme. I guess you are not referring to all those folks who turn 65 and seem quite glad to exchange whatever they have for that dread no-longer novel government-run single payer scheme.
6
always amuses me that what is common in every other western democracy plus japan, and i assume south korea, have national health care plans but poor, pitiful, pious america cannot.
the usa has the worst all possible worlds--obscenely high costs per capital compared to other democracies--and far less individual coverage.
lower life expectancies, higher infant mortality rates....
usa usa usa.
6
K says experts will argue about whether she’s being too optimistic - there’s really no argument about it. Inside him you can feel the conflict between the economist who can do math vs the leftist who ardently hopes for some sustainable way to support huge spending
1
I'm just a knucklehead but healthcare for all unleashes people from fear. All I vote for is fair healthcare and a planet we can live on, the rest will work itself out.
6
Once again not sure if Mr. Krugman is an actual economist or the spokesman for the Socialist party of America.
She passed the test? In what exactly? The wonderful world of made-up math with ridiculous assumption all come true? Where we get huge savings from "government efficiency"? Where taxing companies to death won't lead to a recession? Where billionaire's won't be hiding/shielding their assets to escape taxation?
4
Well, the corporations and the very wealthy already do hide and shield their wealth to avoid taxation as best they can.
3
@Robert ... not government efficiency, rather elimination of "free market" oligopolies...
1
And take away my great employer healthcare benefits? No way will she ever get my vote
4
The saying is that Social Security is the Third Rail of American politics. Well here's another third rail. It's called Medicare - and Medicare for All touches that third rail unnecessarily. The fact is that the American the medical system is just too emotionally and politically dangerous for anyone to touch. Hey, in England the Leave faction lied about the European Union's impact on the British Health care system just to get that effect. Let the Republicans show their ignorance of Health economics like they did in early 2017. Don't give them an issue to take pot shots at. The best Democratic strategy, and Krugman clearly agrees, is to talk about other things. Like the corruption that's leading to Impeachment! Like other GOP corruption! Like out of control climate. Like GOP attempts to prohibit birth control. There are plenty of Republican weakness to point to. Politicians should do politics, not economics. Can Democrats move to universal Medical care systems if they win the White House and the Senate. Yes and maybe. But please stop promising to touch the third rail before you've even gotten on the subway platform. It's unnecessary, and frankly dumb.
2
We gave up years of increased salary for health care benefits. Now you want to take those benefits away from us? (Teachers of America). I don’t think you know who you are fighting for.
Let's just be honest and call the current healthcare industry a parasite on American society, piggybacking on what once was American wealth and prosperity, now mostly preying on the populace to build ever taller skyscraper offices. One just went up in my town, how about yours?
The primary purpose of this industry is to provide jobs for insurance agents and funds for rich, sneaky lobbyists. Oh, and maybe a private island or two.
Remember the famous quote: "We're not in the business of making cars; we're in the business of making money." The same can be said of the health insurance industry as it exists now.
If they were in the business of making America healthy we wouldn't be having this discussion.
6
@Rust Belt Progressive
Amen! And again I say, amen!
1
Dear USA
Please, stop and look at yourself. You are the laughing- (and crying-) stock of the world. During WWII, Japanese bombs finally awakened a global sensibility in you to stamp out tyranny on a global scale, for which (most of) Europe is eternally grateful.
But then, as the new TOP NATION, your government continued to spend enormous amounts of your taxpayers's money on the military (which the Western world is very grateful for), leaving FAR TOO LITTLE for healthcare.
In the 18th century you decided, for a variety of reasons, to "go it alone", and break ties with the U.K. Your frontier spirit has made "Made in the USA" a point of national honor, such that you cannot stomach the idea of following others, including a nationalized healthcare system, unlike most other countries – think Canada and Australia – who transitioned gradually to independence from the UK and now have arguably 2 of the best (and efficient) government-run healthcare systems in the world.
Please wake up and become more than just the military global superpower that you are. Embrace what is happening in the rest of world. Copying the best is not plagiarism, it is common sense. And become a force for good once again.
Please.
6
Warren proposes a "plan" to spend more money on Medicare for All, than the totality of the current US budget. Krugman approves. Thus showing again that the Overton Window often allows the stupidist ideas imaginable to sneak in late at night, covered in vomit, after closing the last bar in town.
3
It does not “pass”. She refuses to tell us that taxes must be raised on all and both legal and illegal immigration severely curtailed to make this feasible.
I want Medicare for all. I need politicians who tell the hard truths and let us push for a better life in this country.
Stop pandering. This means you as well, Mr. Krugman.
3
Cuba has Medicare for All, extremely little income inequality, and an average wage of around $25
per hour?
$25 per week?
no,
$25 per MONTH!!!!!
can't beat that.
4
Democrats care about All Americans, and even foreign citizens and refugees from wars and strife.
But Republicans who have characterized themselves as the party of life, are anything but.
Consider how the Republicans always shower the military with gigabucks in every budget, support the mission of military intelligence aka the C.I.A. in it's constant inventions of enemies, or the support of unbridled gun ownership free of common sense limits, or how they made abortion a social issue back in the seventies that had the effect of increasing the number of them now in the millions, and off course, that means Democrats who support abortion rights are literally destroying the future of their party ranks. The Republicans actually mentally assaulted the public for decades which had the adverse effect of ticking Democrats off into supporting abortion, thus increasing them. Was it deliberate? Or how about how the Republicans have been sabotaging Americans health care since 2010 as they continued to make efforts to repeal Democrat health care programs and proposals?
The democrats are fools for not getting out there and condemning the Republicans as the party of death.
Any plan a Democrat comes up with would be a good plan or stepping stone to the best possible.
3
More lies and deception from the Warren insecurity trap. Please tell her to stop shaking her hands so feverishly, it makes me dizzy. Also can she pay for a new boiler in my house?
4
With the world’s most profitable HC, the big worry is TAXES!-- paid to the govt we elect. Our progressive politicians & media are forced to be defensive and cautious.
But what's a TAX? The excessive charges imposed on us by big insurance/pharma, hospitals & medical industry are like a TAX on us. We have to pay it, or don’t get the service we need for life & death, physical well being & financial security.
We're generations behind other capitalist nations in giving citizens the BASIC RESPECT of guaranteed care. We’ve been propagandized to fear govt taxation for HC, thus we lament but tolerate abuse by our HC industry.
What we need now for this historic election, are details on how real people of varied income levels, in DOZENS of democracies pay for and use their HC.
The mottos of the NYT and W. Post: "All the news fit to print and Democracy dies in darkness"--(?)
But In the age of the internet, why are the 2 oceans and Canadian border big barriers to crucial, comparative information? Our media is so proud of its 'freedom and independence', yet it keeps dark these concrete role models for our debate.
In our great democracy in 2019, Americans have to keep imploring our govt for what multi millions abroad have enjoyed for generations as a right.
Will we be told again, sorry folks, not this election? We’ll say, too bad, maybe in 2024. We’ll wait & stand in long lines to vote. And hope for the least worst candidate to beat the worst president/party in our history.
3
The NYT did not put in a link to Warren's published plan. It is https://elizabethwarren.com/plans/paying-for-m4a. I found it very readable and much more informative than any of the coverage of it (sorry Dr. Krugman)
3
With the world’s most profitable HC, the big worry is TAXES!-- paid to the govt we elect. Our progressive politicians & media are forced to be defensive and cautious.
But what's a TAX? The excessive charges imposed on us by big insurance/pharma, hospitals & medical industry are like a TAX on us. We have to pay it, or don’t get the service we need for life & death, physical well being & financial security.
We're generations behind other capitalist nations in giving citizens the BASIC RESPECT of guaranteed care. We’ve been propagandized to fear govt taxation for HC, thus we lament but tolerate abuse by our HC industry.
What we need now for this historic election, are details on how real people of varied income levels, in DOZENS of democracies pay for and use their HC.
The mottos of the NYT and W. Post: "All the news fit to print and Democracy dies in darkness"--(?)
In the age of the internet, why are the 2 oceans and Canadian border big barriers to crucial, comparative information? Our media is so proud of its 'freedom and independence', yet it keeps dark these concrete role models for our debate.
In our ‘great democracy’ in 2019, Americans have to keep imploring our govt for what multi millions abroad have enjoyed for generations as a right.
Will we be told again, sorry folks, not this election? We’ll say, too bad, maybe in 2024. We’ll wait & stand in long lines to vote. And hope for the least worst candidate to beat the worst president/party in our history.
Just want to remind those who don't live in the D.C. area, and who believe the hokum that Warren and Krugman are trying to sell, that we have a lovely selection of bridges and monuments on offer for you here. All for less than a trillion $.
2
Thank you for another great column.
I just hope you’re ashamed at your News-Side colleagues who talked about “Trillions in New Spending” and failed to mention a good deal of it will come from things like the savings we’ll get from NOT having to pay for insurance - and from the handful of people who have more money than they and their great-to-the-5th generation grandkids could ever spend.
If Paul Krugman, Nobel Laureate in Economics, says the numbers come within range of matching, that’s one fantastic endorsement of a plan.
Only wish he’d run himself.
1
How does Sweden do it? And Japan? Denmark? Norway? Israel? Finland? Germany? Each provides their taxpayers with an efficient, affordable national healthcare system whereas our special-interest corrupted political system ruled by bought politicians repeatedly fails. Our hybrid system delivers 20¢ value on $1 spent, if that much. Many of those same corrupt politicians also claim not to understand why ordinary Americans spend so much for so little. Upton Sinclair probably explained the reason for their incomprehension better than anyone: Convenience. “It is difficult to get a man to understand something when his salary depends on his not understanding it.”
Ecce Congress. Ecce conservative Republicans.
Yes, I know, $20-trillion sounds like a lot of money, and it is. It’s about what the Pentagon will spend on all-things-military during the next quarter-century, all of it borrowed. Borrowed and burned, if spent on all-things-military while our nation, the American nation, disintegrates from within mainly through neglect. While it rots from the inside-out.
It boils down to making choices — spending choices — and sticking to them; making a firm decision about what kind of country we want to leave our children, in what state to leave it, and the kind of state; and sticking to it. Don’t forget for a moment that ruins will be their inheritance should we keep our present course, especially if Donald Trump wins a second term.
2
My god, doesn't Krugman have anything better to do then express his extreme positions on the opinion page - what this washed-up economists gas completely wrong, is that you can address the single most expensive driver of healthcare without a Medicare for all solution - and that's tackling drug pricing - both Pelosi and the President have this in there sights - addressing drug pricing is not dependent on MFA
By her own "magical thinking" numbers, Warren's plan would cost $52 trillion over the next 10 years -- which is more than the entire current federal budget ($4 trillion per year)! Of course this will have to be paid for by taxes on EVERYONE, not just the rich, as Bernie Sanders has rightly said. If the savings don't materialize or costs are higher, the whole economy would get totally crushed.
If you think that the British system of Medicare for All is great, check out some of the wait times, including for cancer, where 25% of the patients have to wait for six months before getting treatment. Five years after diagnosis with breast cancer or prostate cancer, the survival rate of patients in the US is far far higher than that in UK or any of the other single payer countries. (97% in US for prostate cancer vs 83% in UK, and 89% vs 81% for breast cancer https://www.cdc.gov/cancer/dcpc/research/articles/concord-2.htm Of course their medical costs are lower -- that's because they provide less care!
Yes, some of the European countries have greater longevity than the US, but that's not because of medical care -- the causes of that are a lot more complex, including obesity, drug use, infant mortality, etc. For those who have medical insurance in the US (which is 92% of the population), it would be silly to trade that for a UK or Canada like system.
We need to detangle healthcare from employment, and reign in the costs, but Medicare for All is the wrong answer.
6
I really do think that the tax burden should be spread more evenly so that the one percentage pay appropriately, but maybe we and the press should stop making no middle class tax increase the litmus test. That's just a Republican scare tactic. We aren't exactly overtaxed in this country. When someone talks about a tax increase maybe we should consider what it would buy us. Like say universal health care.
3
There is an assumption made that Medicare for all is impossible and too costly. Compared to what? What will be the cost of the Republican plan which is to continue down the current road of doing nothing and letting the free market health care system take up a higher and higher percentage of GDP. Just picture the debate of Trump versus Warren: Warren: all the details down to the dollar. Trump: on day one I will create the best system ever envisioned. Look how hard a sell the ACA was. Now it's more popular than ever. Give people a taste of what better looks like and they will gobble it up. Imagine the working class getting their 'employer based' health care and looking over at the rest of society getting Medicare. The concept 'If you can't beat 'em, join 'em' seems like it would catch on very soon after the Medicare option begins. Why, after all, pay twice for the same thing?
1
Crafting a health care plan is monumentally difficult as presidents from Truman to the current occupant of the Oval Office have learned.
Crafting a QUALITY health care plan is even harder. Any person might deem quality to be found in a plan which offers them everything they want but, since each person's wants are different, an aggregate plan for every person will be unattainable. It is a bridge from illness to health which is complete but lacks its central span.
Take a step back. What is quality?
Quality is the excellence with which a well-defined function is fulfilled. We can agree on what makes a great cake in a bake-off competition or state fair because we have agreed on the definition of a great cake first.
We need to spend some time on deciding what health care is before we plan to pay for it through another Rube Goldberg approach. We cannot leave the description of the target to the doctors, drug makers or any such group who will hold onto their iron rice bowls with a death grip.
How much health care is enough? PBS had a show long ago which highlighted a struggling clinic for prenatal care in a city where one child in a neonatal ICU spent more than the OB clinic's shortfall in its short life. Who decides?
Health care should be compassionate but is compassion spending endlessly to extend the life of a centenarian another month?
First, define your goals. Then explain the funding.
If you aim at nothing, you will hit it.
3
Medicare reimbursement rates are low. How are we to pay for the salaries of all healthcare workers?
2
@Avi Newman
Mr/Ms Newman mentions "salaries of all healthcare workers". As we know the overwhelming majority of physicians are not salaried, they are entrepreneurs, in business to make as much money as they can. We have noticed that these physician businesses are growing in size, in the hope that they can reduce the expense of managing the paperwork imposed on them by insurance companies and Medicare. Besides their cost these medical businesses worry us that the physicians are devoting too much of their energies on maximizing profits, and not on the treatment of their patients. We would love to see physicians salaried as are virtually all members of the scientific community, you know, those people who devise vaccines against terrible diseases, solid state electronics, and the other miracles of the information and space ages. We maintain that if physicians were salaried along with the other healthcare workers, there would be significant improvement in the healthcare system which, of course, would mean lower costs.
@eclectico who is “we” in your response? Most physicians are, in fact, salaried and that has been the growing trend for years due to the lack of sustainability in the current environment of the old “private practice” model. Couple this with the upcoming physician shortage, and targeting physicians is not the answer. The well-documented and overwhelming, manyfold increase in salary expenditures in the HC system goes to administration, not to physicians.
@SenseandSensibility
And who do these salaried physicians work for ? Oh, well of course, a business for whom they are partners. Not the type of business we worked for.
If the slate were clean, Medicare for All would be good. In the current context, however, I worry about the lost jobs in the insurance industry, and the impact this would have on the overall economy. I foresee a public option which, if its cost and administrative economies are that good, would drive private insurers to modify their practices or go out of business.
1
"Even if Warren becomes president, and Dems take the Senate too, it’s very unlikely that Medicare for all will happen any time soon." Well, if so, that's likely to be a problem. We need universal health care yesterday, and out here in working class America, people are dropping like flies around me. If Warren is elected and is frustrated in her efforts to deliver universal health care, there's only so much these folks can take. People will rise up eventually.
And I don't disagree with the concept of allowing private insurance options to coexist, but my worry is that we'll end up with a piecemeal system that does nothing to improve the complexity of the current system: Person A qualifies for coverage B, but only in case C or if one's income is below threshold X, in which case you pay Y, but if over you pay Z, etc. This is my fear. We need a system with NO OUT OF POCKET.
2
The mistake Senator Warren made was in thinking she had "to counter criticism that she was being evasive on a big issue". Who was being critical? Her fellow nominees and the endless talkers on what used to be the news channels. Not, in other words, a real live voter. Now, she has this plan, which can be picked apart and judged by these same critics, and will have to be endlessly revised or adjusted as the Senator continues her campaign in order to counter the counter-criticism. She should have just stuck with the big idea, which is what brings people to a candidate anyway. People understand that the ideas count, as well as that the crowd in Washington D.C. will do everything possible to reduce it.
4
@David Godinez
Agreed. Answers too promptly. Shows her hand too early. She's not even nominated yet. Repeat of the "native American ancestry" challenge? She must learn to bide her time and not be at her detractors' beck and call. Here is to E. Warren, our next president.
I love the Medicare for All plan, single payer at it’s best. Will it make it through Congress, probably not without some serious revision. But that’s politics. The fundamentals of her plan are sound.
As I have suggested many times before, everyone should look at the PNHP plans, the physicians for a national health plan site which has been running for about 20 years. PNHP.org
This is where everyone will get many useful ideas.
4
Any plan that costs $20.5T and isn’t supported by both parties isn’t serious.
3
What’s the point of a plan that you gave no intention of trying to pass into law? It the definition of pie-in-the-sky. I for one don’t like my politicians to pander. Besides her plan undercuts the benefit of a national system. By forcing companies to pay, you keep negative pressure on companies to hire.
4
At the end of the day, universal health care is worth it, but there is a cost, Dr Krugman, and Senetor Warren, are consciously ignoring how costs will go down.
As a Canadian, i can tell you two things:
1 - Doctors salaries are a lot lower, especially for specialists. That is why Canadian Doctors go to the US.
2 - hospital costs are much lower. This means hospitals will need to be re organized to lower cost. Consolidation and lay offs are the order.
9
@Tom I may be a bleeding heart liberal, but beggar health care providers as we have our teachers, and depend on Congress to maintain sufficient funding? No thanks!
2
@Tom So, let me get this straight:
1. doctors' income levels must be maintained at all cost, or they will leave the country.
2. hospital inefficiency, sky-high executive compensation, and overcharging, must be maintained in order to preserve jobs.
In other words, the status quo must be maintained. Making sure that everyone has access to health care and making the system run more economically must take a back seat, or else. I understand now.
5
@Mitch4949 Not at all, Mitch; rather, build upon the ACA to improve affordability and efficiency instead of swinging for the fences. An election's coming, not revolution.
2
Paul,
Thank you for assessing Warren's medicare for all plan. Your analysis leaves me now thinking that Warren is not realistic nor honest in her thoughts on providing health care for all. By laying out the details of her plan, and bringing in experts to fill out these specifics, this ambitious platform position now has a degree of possibility. Sure, it's unlikely all of America will buy into it. But your analysis helps bring Warren's finally-provided specifics into focus now. Thanks....
3
Medicare drives the USA health care market. Medicare sets the prices and is the largest insurer. It is an insurance. One must pay premiums. It covers 80% of most services. You can buy an insurance rider for the other 20% or pay out of pocket etc..
Then there is Medicaid which is for low income and then Private Insurance. Keep in mind that when Medicare was started the goal was for everyone to be covered by this insurance. You can still carry private insurance if you want and not use your Medicare. You must pay for Medicare to have it.
The issue has been that Health Care is for profit in the USA. In most countries it is non profit. And our insurance industry is very powerful to keep it this way. When the Obama Care was enacted the prize to private insurance was that they would manage the Medicaid money.
The USA in my opinion is behind Europe several hundred years for many social systems. Our health care system has developed in a stepping stone pattern. These grand schemes mentioned, to me are abstract dreams. I believe a public option for health care would be a more logical concrete step.
3
This explanation of Warren's health insurance plan makes sense but I'm worried about how bringing another 25 million into the system will affect me. Will doctors including my own retire en masse? And I'm not affected but haven't I read that up to two million current employees of insurance companies and doctors offices etc. lose their jobs?
1
Why haven't any serious economists discussed the obvious:
Employer-provided benefits began as a way for businesses to get around wage-price controls by offering employers the opportunity to deduct the cost of insurance while, effectively, increasing compensation of employees.
A simple change in the Affordable Care Act would produce the "market-driven" system that so many claim to want:
1. Remove the employer mandate.
2. Eliminate the tax deduction for employers providing health care.
This would, likely, cause employers to pass much more (if not all) of the costs to employees or drop subsidies altogether.
This, in turn, would expose employees to the true costs of care which, I suspect, would result in a public backlash against the providers and pharmaceutical companies and a demand for REAL reform.
People who say that they don't want government health care miss the point. Allowing employers to deduct health care costs for employees means that the revenue lost by the government has to be made up somewhere else.
That "somewhere else" is US!
9
"Well, America does pay incredibly high prices for drugs compared with other countries, and the complexity of our system imposes a huge administrative burden — not just the overhead of insurance companies, but the sheer number of people doctors and hospitals have to employ to deal with multiple insurers."
Dr. Krugman mentions an interesting paradox: Republicans and many Dems support the private insurance-driven healthcare state that functions like a communist government. It provides more jobs than necessary given the option to reduce the bureaucracy through a single-payer system that is often termed socialist.
2
You can get to medicare for all simply by allowing a buy in by any citizen. Private insurance won't last 5 years.
8
The author completely ignores the mark to market capital gains tax increase. Unbelievable. Quite a tax bill as a house increases in value. Or in multiple other areas like employee stock plans, or plain every day vanilla investments the middle class makes. And also the huge payout she is handing doctors with Medicare rates. We will have all the best doctors opt out of Medicare, creating a two tier medical system. The unions alone will object to this. A public and private option is best as exists in all European countries despite perceptions otherwise.
2
HOW has she "passed the test" when you note that her plan will probably never happen? Pass along taxes and expenses such as she describes will never, realistically pass Congress. Jobs will be lost as employers are required to pay matching costs and get nothing, e.g. employee loyalty for it.
A plan is good if it has any chance of becoming reality.
1
I have no horror stories about my private health insurer. I’m pretty healthy but have had my share of scares and pricey procedures, all of which were covered with no problem.
However, I’ve been on Tricare for several years now and, for the first time find myself fighting for coverage. And losing, I might add. As an example, Texas requires private insurers to cover 3D screening mammograms, but Tricare will not approve them. They aren’t covered under Medicare, either, unless that has recently changed.
I’m not really complaining, as I am happy to have Tricare, but people should understand the limitations of single payer. There will be choices required, and the idea that everyone will have access to the best of everything and that it will all somehow even out without major tax increases on everyone is just absurd.
3
An op-ed piece here last month argued that a VAT would be much more effective re the 4th component, rather than trying to tax wealth (via the current tax code). Would be good if she could pivot to a VAT, but am afraid she's now wedded to a 'wealth' tax (which would be good were it more practicable - which I don't think can be).
1
It’s still evasive if the numbers don’t add up. Read some of the analyses from other sources. (Not Fox News.)
The majority of Americans, especially in the crucial swing states, want to keep their current non-government health care plan. How does this position make Warren electable? Democrats need to nominate a candidate who can win, then have the debate about single payer.
2
How about more emphasis on preventative healthcare? Getting rid of vaping, taxing cigarettes out of existence, limiting toxic industrial emissions,getting diesel exhaust out of cities,cleaning up river water,gun control?
10
@David B. Or taking away people's forks? That's the problem. We eat too much.
What would the net effect on federal government revenue be of losses in taxes from the health insurance industry and any affiliated businesses that could be eliminated, and how long would it take for people currently employed by those businesses to find new jobs? Not necessarily determinative, but a potentially relevant issue to be considered.
3
This idea that increased enforcement by the IRS can produce a lot more revenue is a banana republic idea.
3
@Getoffmylawn Not at all.
The average person don't drink their coffee with their intellectual pinky in their air. Ok, she has a plan now, it's just no one can really put a price tag on it. I like Warren. She's bold enough to campaign on even having an MFA program. After she wins then she and Congress will have to hammer out the details. Obama’s administration made the mistake of giving too many details of their vision that was then turned upside down in Congress. Warren wants to avoid that mistake.
12
I currently have a $300 deduction in my social security to pay for Medicare. Does this go away?
2
Here’s a better and much cheaper plan...
Change Medicare eligibility age from 65 to birth. Leave VA, military and Medicaid intact. Employer healthcare plans stay in place, except with Medicare as primary coverage. Employer plans become secondary, or convert to Medicare Advantage plans. Currently about a third of all Medicare eligible Americans are enrolled in Advantage plans which are compelled to compete with traditional Medicare on price and coverage. It would be difficult for the Supreme Court to find the venerable Medicare law unconstitutional simply for a change in the eligibility age.
Medicare would continue to be funded through a payroll tax, but at a higher actuarially determined rate, while employers would be required to continue their current levels of support for healthcare by paying their half of the tax and returning any cost savings to workers through reduced contributions or increased wages. That will preserve all union-negotiated benefit levels.
A payroll tax makes healthcare affordable because it is a function of ability to pay. High earners will pay more, just as they do now for the existing Medicare plan.
The overarching goal, of course, is to achieve universal healthcare coverage and substantially reduce the cost. Only government through monopsonistic pricing and the force of law can achieve that goal.
Jim Salmon, CLU, ChFC
Director of Underwriting, Horizon Blue Cross / Blue Shield (Retired)
32
@Jim Salmon Or, we could eliminate the real problem, the greed of parasites like Blue Cross/ Blue Shield, parasites that add zero value and are completely unnecessary.
America’s national healthcare needs examination. Look at past performance, then ask a two-part question with regard to any change, simplified for this piece. If we make no changes, will that be catastrophic? What are the costs & risks of change? Elizabeth Warren has proposed universal coverage for $20.3 Trillion. Evaluate that dollar amount w.r.t. history then pose the two part question.
America's healthcare system has private insurance corporations offering "coverage" that citizens directly buy or MAY receive as an employment perk. The wealthy 1% can pay cash for excellent services. This insurance system fails tens of millions of Americans who are uninsured or under-insured. Premium costs continually rise, coverage is imperfect and out-of-pocket deductibles are $$$.
Most modern nations have some form of nationalized health care. These nations aren't bankrupt and their citizenry is not catastrophically dying from "socialized medicine".
Is Elizabeth Warren’s $20.3 Trillion Medicare-for-All too costly? Total up costs employers and citizens pay for insurance, add administrative costs to run hospitals and medical staff PLUS hidden costs by uninsured the system absorbs. My guess is its more than $20.3 Trillion but we must do the math before dismissing Warren’s plan as socialized medicine or stating it’s too expansive. And remember, any change will be analyzed in the future then changed as needed since nothing is perfect, but...
Doing nothing is not an option.
10
Notice that Trump is not attacking her. Trump will wait until he knocks Biden out of the race. The only candidate that beats Trump by a wide margin in the swing states which are the only states that matter. Warren is behind Trump in the swing states! Biden is the Dems ticket to victory! A blue wave will capture the Senate and hold the House. There will be no Blue Wave with Warren.. Focus on beating Trump. The Dems can debate these issues after Trump is gone..
6
When you remake 1/5 of the American economy, you must also consider unintended consequences. One example, if something is free Americans and greedy physicians will abuse it. That’s just the way our society works. One reason insurance companies put you through a decision gauntlet for an MRI is that physicians in many parts of the country have purchased this equipment and then order the test. Unnecessary over-testing is already a current challenge in the existing system.
I cancelled my ongoing contribution to the Warren campaign because I don’t believe it’s a winning campaign strategy to advocate for such a dramatic upheaval of the economy. While Krugman thinks not to worry it will never be implemented that isn’t how voters make a decision. American voters like simple CLEAR choices. Republicans will easily scare the heck out of voters with all the possible unknowns and increase the possibility of re-electing Trump, a risk I’m not willing to take.
Furthermore, I am content with my employer based coverage. I just declined Medicare to stay on my spouse’s plan. I had a choice. Don’t take that choice away from me.
Lastly, you will never ever convince me that I would rather call the government than Cigna. I called Social Security and waited on hold for an hour. I call Cigna and help is on the line in minutes.
I want Trump out of office. i switched my support to Pete B.
11
@Patricia Brown
I heard Warren speak in N.H. Someone in the audience told her about the wonderful health care benefits she and her husband had through his job and how she would be loath to give them up. Warren said, simply, "I want that for all Americans." I do, too, Patricia. (But we don't want to threaten YOUR prerogatives, do we?) There's too much "me, me, me" in this country; that's the crux of most people's arguments against Medicare for all. "I got mine, who cares about about you?" Sounds more Republican than moderate Democrat to me. And do you really think a gay, intellectual mayor has a better chance of beating Trump, even if he avoids advocating good health coverage for all Americans? That's risk I'm not willing to take. Warren is clearly the best choice.
6
@Patricia Brown . I understand your need for choices, but take umbrage with your comment about "greedy physicians". As a retired internal medicine clinician, I can tell you, the decision to order MRI's or other tests is not done lightly. As a mother of a low risk daughter with stage 3 breast cancer, that never was picked up with either clinical exam or diagnostic mammogram, I am thankful for the MRI. Greed is a derogatory term, that certainly does not describe any of the physicians, advanced practice clinicians , nurses or other healthcare professionals I work with either as a patient or a colleague. These caring who would consider a 50 or 60 hour work week "an easy week", compared to the usual 70-80 hours while being paid for 40.
I can think of may other professions and businesses where this term is more applicable, likely found in the top 1%.
5
@bjkf You must not read the same newspapers I read, which describe a devastating opioid crisis from prescriptions written by greedy physicians. I'm not suggesting that the vast majority of physicians are greedy; I'm saying enough are to waste billions of dollars in our economy. Physicians should not be allowed to take free trips and receive gifts from big Pharma. Physicians should not be allowed to own medical equipment that they can then write prescriptions on. I read about Medicaid and Medicare fraud all the time. In every single case, a greedy physician is involved. That is the right adjective for the crime.
1
All of the reasons given here for supporting Warren's plan are also true of Sanders' plan, except that Sanders admits that the cost of the plan would come through taxation rather than through paying premiums and deductables. I think it is true that some people who consider themselves middle class (just about everyone) would see their taxes will go up, but their overall costs (taxes + medical care and insurance) would go down.
This is because a single payer system would be more efficient than what we have now. Also, there would be a savings in the waste that is now devoted to advertising. This would be a loss to the entertainment industry, which may help explain why the news media is is continues to provide a negative spin on a single payer system.
6
Yeh, I loved my last private insurance plan with its $10,000 deductible, 20% copays and $5,000 annual premium for a plan with limited medical choices. As a retiree and Medicare recipient, I pay $130+/month and $40/visit to see a specialist of my choice. Right, bring back my private insurance - please!
29
@Mister Ed As a retiree you are not required to take Medicare. As a retiree you can buy private health insurance. Oh, that's right, you really cannot afford your private insurance as a retiree.
It’s a plan and that is at least something. She is right that the cost of healthcare and drugs is s large part of the problem. There is simply No political will to stand up to drug companies and providers who can name their price and forever extend patents here.
A couple of criticisms. I’m not for serious taxes on corporations. They may not pay what liberals think is enough tax, but they hold their end of the bargain by employing millions of people. My employer has employed many more people and I got a decent raise in the last 2 years that I put down to favorable tax conditions. The knee jerk reaction to raising them will be layoffs; In a free market economy where profits and protecting the share price are a necessary evil then it’s a cold hard economic certainty that raising taxes will lead to unemployment. I’m not going to be the turkey who voted for thanksgiving.
Secondly I want her to answer on the debate stage with one word, yes or no, will she raise taxes on the middle classes for any reason. For people in New York this is important because we are already tax gouged and can little afford more. It would be a pre requisite for me to even consider casting a vote for her.
1
@Hjb
As opposed to voting for Trump who already raised your taxes once?
On the news last night it was said of her policy that there would be no more co-pays or premiums.
She must not know that the current Medicare plan has both premiums (which go up every year), deductibles, and co pays.
In addition to Medicare one must have some kind of supplemental such as Medicare Advantage or the Medigaps programs. Medicare and its supplemental are NOT inexpensive. Is she going to get rid of those as well?
5
@esp
My brother's wife has a Medicare Advantage plan. She paid $14 a month. Next year she will pay $0.
@Stephen
Yes and it is more than likely a HMO which means she cannot see a doctor of her choosing. Has to hassle with out of network doctors if she doesn't have a referral from her primary. And she may not be able to get treated if she travels because they do not have an in network provider. Furthermore she may have to hassle for the care she needs and could get excluded from some things.
I also have a Medicare advantage program. Mine costs less than $60/month and it is a PPO which means I can see any doctor I want anywhere. As a nurse I would NEVER sign up for an HMO.
And that may well what will happen when we have Medicare for all. We will NOT get to choose our doctors, hospitals, dentists, etc.
And she will still have to pay the Medicare premium which will go up to $144 next year.
Unless she is also on Medicaid.
Wish your sister well with her new insurance coverage.
I was just in a top notch hospital and as a nurse, I know I did not get the care that I should have gotten for my condition. I wrote letters. Basic standard nursing care that would prevent me from developing complications
Bravo!
One data point. I just picked up a 90 day supply of Xarelto 10 mg pills (one each day). Cost $283.38. Receipt says my insurance saved me $1329.11. Pharmacist says that is what my insurance paid.
How much do Canadians pay for a 90 day supply of lowest dose Xarelto?
It seems as though the system is saying "Your money or your life?"
8
@Rita Lombardo My 90 day supply of Xarelto costs $105 for the first 3 months; then $105 for the next 3 months. But then I start going into the infamous "donut hole" and pay $233 for the next3 months, and a whopping over $400 for the last 3 months of the year. That donut hole (thanks, Repubs) needs to be addressed under any medical plan overhaul.
6
@Rita Lombardo
This is ridiculous!
1
@rebecca1048
Agreed $17.92 per pill each day is ridiculously outrageous for us to pay.
You know what is the best part of Elizabeth Warren's plan is? She actually has one. If she's elected there is a very good chance that Healthcare Reform based upon this plan will happen. This is much different than then candidate Trump's promise to repeal and replace ObamaCare on Day one. It is now Dat 1,015 and we are still waiting for Trump's Plan.
19
What will happen to the thousands of individuals who are currently employed by insurance companies?
They are supporting their families, paying their taxes, shopping locally. They aren't the empty suits in the corner offices making seven figures plus stock options.
Does Warren have a plan for that?
6
@Emile deVere
Those people will go the way of all the other people that have lost or soon will lose their jobs to robots, but at least they will have Medicare, unless they have to pay the premiums, co-pays and deductibles (and supplementals) that current Medicare people pay.
5
@Emile deVere Did you ever think about the fact that many will just go to work for Medicare?
2
@alan What Emile meant was that there would be NO jobs for them to go to. As is the case with a lot of people whose jobs have been replaced by robots. More and more of those every day.
Things are not going to get better in the United States.
Health care in the US has to be recognized for the absurd and unsustainable racket that it is. It needs a ground-up reconfiguration and some recognition that an essential service cannot be handed over to the greed and corruption of 'providers'
The Swiss system is a hybrid of private care with strict controls and it works very well. I NEVER hear of bankruptcies here due to medical bills.
31
@Plennie Wingo When I studied more than a half dozen plans from countries like Germany, Switzerland, Britain, Canada, France etc., I determined that what would work best for my family's situation would be Switzerland, then Germany.
1
@R. Anderson I live on the German Swiss border. Our town is filled with Swiss coming here for dental work, eyeglasses, and other medical services. Why? Because they drive across the border and get all of these services far cheaper than in Switzerland, and the Germans providing the services love money in their pockets.
1
As a physician I can tell you that this plan won’t work. The cost of medical care is absurdly high and unless that’s addressed implementing any new plan is foolish. I recently had a pelvic CT Scan. Medicare was billed $6,500 and that’s what they allowed. Are you kidding me? Facility fees for doctors whose office happens to be in a hospital? $400 for sitting in a chair, using their elevator and maybe the rest room? The culture of healthcare delivery and the practitioner must change. Procedures should be price-tagged. The cost of a procedure shouldn’t vary because of the patient’s insurance. I understand private insurance is bilked to make up for the under-doggier insurance which is bilked for the next low paying insurance. And when you come to the end of the line you have Medicaid which pays so little it’s obscene. Surgery which could be performed in an office is sent to a Surgical Center, often doctor owned, and they’ll bill far more than the surgeon will ever see. Every doctor who wants to add thousands to his income will simply lease diagnostic equipment. Run a few tests a week and it’s another $50-150K a year.
Sadly we don’t get the best bang for the $ compared to other countries. We just pay higher premiums and accept it. Real change comes from reforming the system not innovative ways to absorb the high cost. And the attitude of the patient is ’I don’t care what it costs as long as I’m not paying.’
23
@woody3691 Norwegian doctor on the line here. I understand what you're saying - I think one needs to be a health care provider to do so. It´s difficult for the general public to understand that 1) the demand for "healthcare" is infinite, and 2) any system where investigations generate more revenue for healthcare providers, will drive up the number of investigations done. From what I've read about the U.S. "system", this can become quite extreme - e.g. colonoscopies performed without (strictly speaking) a proper indication! I'm guessing this will be difficult to change, as a whole lot of doctors are accustomed to the system being as it is, and from my experience here - where there are list prices for procedures - it'll be difficult to get doctors to agree among themselves to changes. However, give EW credit for trying to stimulate change - change is needed, I think.
18
@woody3691 this is absolutely the problem. It’s the cost of treatment, more so than who pays. Under a publicly run scheme, providers should be told exactly what they can charge and commonly used generic drugs like aspirin and paracetamol should be freely available.
Reign in the cost and completely unnecessary over treatment of patients and maybe you have a basis for a workable single payer system. The question is how you get from here to there.
4
@woody3691
I agree that something needs to be done about the runaway costs, but it seems the goal of those entering the profession, nowadays, is to get rich. I would love to hear one say he or she wants to be a doctor so they can save people.
2
Other cost savings are implied, which Krugman didn’t notice:
Medicare, as it stands, has quality improvement incentives through reimbursements that contribute to long-term increase in member health. This could be generalized to the entire health care system.
The pool of healthy members allow coverage of more-expensive members (which is what the “Individual Mandate” was about). A large percentage of persons under coverage would be very low cost, and the lack of persons with coverage would ease costs to local urgent care facilities, thus making state involvement in cost coverage easier and decreasing life situations which have to turn to urgent care facilities.
Obviously, transition from the current market would have to be gradual, so Medicare for any adult age could easily be a public option while employers and employees adjust.
Employer payments to health insurers are addressing corporate need for profit which would disappear with Medicare for all, so employer contributions would become less than what they’re paying now.
2
@gary e. davis Error: "...the lack of persons WITHOUT coverage would ease costs..."
Warren’s plan is a joke. It passes no test, not even the laugh test. Maybe we should transition to single payer, and maybe we shouldn’t (I’m in the latter camp), but her numbers simply don’t add up and anyone who knows economics knows this. Taxes must go up on the middle class to pay for this generous benefit. At least Bernie is being honest about this fact. The notion that the rich are just going to sit there and let the socialists confiscate their property is a very aggressive assumption. I don’t buy it. Also, the wealth tax first would have to get passed (unlikely) and then survive constitutional review (impossible). I know Warren is open to “packing the court” in order to get judges that can overlook the constitutional defects of her various plans, but that’s, in addition to being one of the worst ideas proposed in recent history, no easy task. First, of course she has to beat Trump the odds of which are very low. Insurance companies should rest easy. They aren’t going anywhere.
12
@Bob I wonder if this shows a little too much faith in the power of the rich. What exactly will they do, apart from literally moving offshore? In Australia, if memory serves, Bob Hawke retroactively cancelled most of the offshore loopholes. A very few folks opted to indeed forfeit their properties and move to Europe, etc. Most just held their noses and their discretionary millions and bit the bullet.
@Bob So what is your solution? People with diabetes should not be dying because they cannot afford to buy insulin even with the co-pays. At least Big Pharma has to be reined in!
2
@Bob
I'm not so sure the wealth tax would fail as unconstitutional. As long as the tax receipts are returned to the population on a per capita basis, the constitution appears to allow it (that restriction was the reason a constitutional amendment was necessary to impose the federal income tax). Since every citizen would receive insurance coverage, that test could well be satisfied.
1
After being taken to task on this issue by the other candidates in the last debate, I can only congratulate Warren for producing a coherent plan. Now she needs to drive the numbers home to working-class constituents: minimal tax hike in exchange for very significant healthcare savings at the end of the calendar year. She is my candidate and has been since the moment she made the transition into politics.
17
@Kris Warren: "Oh and you elderly on Medicare, Advantage and Part D, and all you middle class folks and everyone else who polls show are happy with their private healthcare… you'll be losing it."
Voter: "let's see, where's that Trump hole on the ballot!"
1
Before medicare, I had private insurance which meant that I fought for benefits each and every month. At least five times I sent lawyer letters to the insurance company and threatened litigation if they refused to pay for benefits clearly articulated in the policy.
With medicare & AARP, I spend that time going to the gym to keep myself healthy.
My guess is that most people have a similar, awful experience with private insurers whose goals are diametrically opposed to mine.
Medicare for all? By all means, bring it on.
54
@Monty By "bring it on", you are aware that your Medicare will be going away right? Medicare for All is a replacement for Medicare and all its variants, not actual Medicare.
2
@Marshall That's right Marshall, It's Improved and Expanded. A better product for less money than we spend now, per capita. What's not to like?
10
Perhaps the public option will "have a better chance of actually becoming reality" . But only because people like you, Paul, don't have the courage of their own thinking. The very overhead cost savings of eliminating multiple insurance companies --as well as obscene profiteering-- do not go away with a public option. In fact, another insurance product only further complicates the field and will subsidize the private companies through adverse selection. And I am not sure what "other studies" you have perused. But ALL the studies supporting Bernie's Plan and PNHP definitely account for these administrative cost savings.
3
The elephant in the room remains the same: we spend 50% of our healthcare on the last six months of life. The insanity of $100,000+ treatments that extend life by one or two months, and using critical care instead of hospice care for the dying, etc., must stop. Figure this out and we won’t need Hail Marys from Elizabeth Warren.
18
@Pragmatist in CT That is a point very well taken, but it misses mentioning that $100,000+ should not be the cost of those critical care treatments. Hospice care probably is more often the right choice, but hospital overcharging also needs to be addressed regardless of how many patients we think it should serve.
26
@Claude G True enough, Claude. so long as “other peoples money“ is being spent to keep grandma alive, it’s an easy decision to make. One quick and simple way to dramatically change this wasteful spending is to add a $50,000 premium that the family must pay to continue treatment after doctors determine that hospice care is the best next step.
5
That won’t fix the fact that we still don’t cover everyone.
1
Dr. Krugman,
Thanks for explaining this. I like it. Especially factoring in the part about maintenance from States.
I believe Senator Warren could sell it once she got into office.
And, one other thing, it would be good if all of the "responsible" media stopped talking about the Senator being unelectable and concentrate on stating the truth that, slowly but surely, she is convincing more and more to see her strengths.
...and, if there were ever a more "UNELECTABLE" candidate than DJT, I have never heard of one.
22
@Blanche White Except that he was, and if Warren (or Sanders) is the nominee, probably will be again, impeachment not withstanding.
2
@Carl Yaffe
My point, exactly, that the most unelectable candidate "ever" won. So, it's probably not a very smart thing to call anyone unelectable.
Will DJT win this time? NO. There will be enough turnout this time to overcome gerrymandering and, with some fervent watchdogs out there, voter suppression might be a voter stimulation instead. ...and the Russians have made us a bit more sophisticated so their social media tactics are a little more obvious now.
6
@Blanche White I certainly hope that you are right! No American should take election turnout for granted. No matter the Democratic nominee, all progressives, liberals, left-leaning moderates, anti-Trumpers, and even worried conservatives should support her/him, because the alternative - "leadership" by Donald Trump and his feckless supporters - is so damaging to this country. (Oh the irony of Make America Great Again!)
If you disagree with Elizabeth Warren's progressive health care plan (or any of her plans), you can be assured that there are checks and balances; even if both chambers of Congress were controlled by Democrats, it's unlikely Warren's health plan would pass. It's best not to fixate too much on it! I put my trust in Warren, first and forememost, because I believe she will surround herself with a capable and experienced team who will "fight" for issues I care deeply about - climate change and protection of the environment, as well as attempting to adjust the imbalance of power between the wealthy and less well off.
4
It’s a shame that such an intelligent and eloquent person would choose a plan that would be enormously disruptive to the healthcare system and as importantly, take away peoples choice in how they pay for healthcare. I think that this plan dooms her candidacy as the only number that will be used will be the headline numbers. Doctors will apples the Medicare level/ payments and drug companies will protest the huge cuts in drug prices. Fighting the entire HC establishment at the same time is a foolhardy exercise. With this plan, Warren cannot win the presidency and democrats should now unite to end her candidacy.
14
@Sipa111 You make some good, valid points but what's YOUR plan? I like the combination of a public option designed to out-compete private insurance along w/ universal, public catastrophic/chronic/wellness-preventative insurance.
2
@Sipa111 We have only one choice about no we pay for health care -- through the nose.
2
Plenty of problems with this proposal from a person living in the wonderful land of socialized medicine.
First, the current system allows businesses to provide different level of insurance benefit based on the negotiated job compensation as a tax free benefit. The government would be unable to provide a system that matches this sophistication and would have to apply a business tax probably based on the level of salary to fund Ms Warren's Medicare for all. It may not be a "middle class tax" but guarantee it will be on every employees pay stub looking like a tax.
Second, many healthcare providers lose money with Medicare patients. There would be a huge drop in supply and probably of quality. This would lead to healthcare service queues or lines for clinics like those found in Canada, Ireland or the UK. This would cause outrage in the US. So to maintain the same level of service would mean that the cost of the program would have to increase Medicare compensation significantly. This means that Ms. Warren's proposal has significantly underestimated the costs involved.
Third, the gains in efficiency, cutting government waste, etc. is all fantasy world financial modeling. Guarantee that any bill that makes it through Congress has more inefficiency built into it to satisfy the thousands of special interests that will want a piece of the action.
9
What should cause outrage is the fact that many of our citizens are uninsured or underinsured. No one in the richest country in the world should go without healthcare. Other countries can do this. So can we.
11
@Smilodon7 Just to clarify, the US is NOT the richest country in the world... we're now 10th to 12th based on the measure... and falling fast!
Having said that, agree that we certainly have the financial wealth to provide basic health care to all citizens.
8
@Smilodon7 I thought Obamacare was supposed to solve that? It was certainly sold that way… just like this plan.
Warren’s plan may not make it through Congress, but to get even to the public option, you have to start with a proposal radical enough to allow moderates to come to the public option as a compromise. If you start with the public option, you will be dragged to something less—like Obamacare.
17
I like Warren, but she will not become president for the same reason Trump was elected. Half the country see’s her as elitist, and people want a voice they can identify with. Sanders has a better shot.
4
@Emily
Trump is an elitist. Have you heard him dis elites to his crowds and in the same breath say to them "we 're the elite" They cheer on both accounts and clearly do not register the dissonance in his remarks.
Warren is a poor girl from the mid west with a great brain.
She speaks more to half the county than trump.
I find it disheartening that pundits on the left and right — as well as Senator Warren’s competitors for the nomination — still harp on the idea of middle class taxes rising under a Medicare-for-all type plan. If your taxes went up by $1,000 a year and your $1,000 share of your health insurance premium went away AND you eliminated that $1,000 deductible before your insurance paid a dime, wouldn’t that be a good deal?
Warren should stick to her guns and keep insisting that as long as your total costs go down, it matters little if your taxes rise.
35
@1954Stratocaster
Absolutely, my dear. We understand that two plus two equals four, don't we? Who needs media mongrels screaming "but will middle class taxes go up" and then yelling gotcha?
Yes, just think no deductible or this and that which insurance companies constantly massage and tweak to get one more nickel or dime.
And, best of all, no need for us fortunate insured to worry about the desperation of millions of uninsured.
...........LESS WORRY PERIOD...................
1
Senator Warren has a presidency to lose. Even if her plan is the most expensive, it is a good faith, responsible, honest plan with successful examples in the developed world. It took her a few months on the campaign trail to put it out. That is more than can be said for the Paul Ryans and Moscow Mitches of the Republican party, who took a decade to produce crickets. How the Trump base fails to see this one obvious fact, beyond all the numbers and details is beyond me.
40
@Essar Indeed, Senator Warren has a presidency to lose. And if nominated, she will, thank heavens.
5
Senator Warren has a presidency to lose. Even if her plan is the most expensive, it is a good faith, responsible, honest plan with successful examples in the developed world. It took her a few months on the campaign trail to put it out. That is more than can be said for the Paul Ryans and Moscow Mitches of the Republican party, who took a decade to produce crickets. How the Trump base fails to see this one obvious fact, beyond all the numbers and details is beyond me.
3
There are a lot of things that make warren's plan a non-starter.
Funding coming from corporate savings by eliminating private insurance? - I don't think so.
A tax on high net worth individuals - look for a Trump book written in prison called "The Art of The Steal" - He claims to pay no taxes now, why would he do so in the future?..and why not share his experience with the trolls who wander the halls of Mar-a-logo.
Extra tax on wages over $400k? No way, there's lots of legal ways to compensate an employee without creating an "earned Income" tax burden.
It goes on and on and on - Warren is smart, but. her understanding of micro economics appears to be somewhat below that of the average Labrador Retriever.
It's a good idea, but so was the zeppelin, and look where that got us.
Sorry Lizzy, you're not going to get the nomination let alone become President.
6
@William Pretty condescending. Since there's just no way to get the robber barons to pay, we might just as well forget it, hmm?
2
Savings from tax enforcement? COME ON. What would you have said if Paul Ryan included this in one of his plans??
Sad thing is that there wasn't even any need to construct this so that there is no tax increase. She had it right the first time, which is that net-net families will save. Why not try to explain that?
Now we're firmly into "it will never happen so it doesn't matter" territory.
4
It's going to take a lot more then Medicare for all.
It's time to reign in the medical & pharma establishment with their cost structure. What does that mean?
It means bringing them into a more stable cost of using their services.
They are definitely the problem with there greed and making their bottom line for their shareholders.
We are all human and it's time to treat all that way, instead of the money aspect in our society.
WE THE PEOPLE and and not WE THE CORPORATIONS.
Think about that......
5
@Kev
Yes.
Every country that has universal healthcare also regulates the prices that hospitals, doctors & drug-makers can charge.
We don't.
That's why we cannot afford healthcare for all . .
UNLESS
1) We let employers continue to offer health insurance to employees who
want it &
2) We improve Obamacare by raising subsides and bringing more healthy
young people into the pool.
This will happen.
Warren's plan never will pass & she knows this.
But she is bent on winning the primary, even if that means lying.
2
That’s the whole point of Medicare for All, aka single player (that one payer being the US government).
As long as there are multiple payers in various insurance companies and options and whatnot, we can’t force the companies’ hands.
We basically need the power of unity to say, give us the drugs cheaper because there’s one player in town and if you don’t like it, tough luck. It’s like a nonprofit monopoly that’s goal is better health for cheaper prices.
Other countries do this and that’s why their healthcare costs less.
4
If Warren had President Obama's skills, she could implement Medicare for All as an executive order.
1
@RandyJ
And have the next Trump-wanna-be elected after her, deconstruct Warrencare?
So many in coal-country suffering from black lung and gasping for life, claim that Obamacare is paying their medical bills, and yet won't credit Obama for saving their lives/ or at least extending them. Has the coal-dust entered their brain as well?
Oil and gas industry has been the recipient of tax credits, tax deferments, tax exemptions and then the 2017 tax break boondoggle. Exxon paid 11% in 2012. Oil is the poster child of the US welfare system-Not healthcare.
Prof Krugman is giving Warren some cover—-she did her homework, finally—-it’s late! Biden was right: tens of trillions of dollars in costs and 9 trillion in additional taxes. Corporations will adjust those massive expenditures to American workers.
Warren would be the most fun teacher of the budget but Biden despite his gaffes has a better working understanding of what can be done. Warren has been touting universal health care without having done the math.Sad.
1
Normally agree with you Paul but you’re way off here. It’s a pipe dream like bernie wiping out $1.5 trillion in student loan debt.
Twenty trillion dollars for what? Another huge bureaucracy that won’t function. To be paid how? By “redirecting” money to the government and raising corporate taxes? No, by taxing everyone to death, including the middle class.
The likelihood that most Americans, including the middle class, will benefit? Extremely remote. The entire plan is a political stunt. Like getting a blood test to prove your lineage. Or changing stories about your background to suit the circumstances.
The only reason she has a plan to pay for the plan is because everyone, including those in her own party, questioned the reality of her plan. Her plan for the plan fails miserably.
6
@Mark
Yes, I'm afraid Warren's plan--and her explanation of how she would pay for it-- is simply a political stunt.
The numbers don't work.
And she knows it. She is an very
smart woman.
But she also is a fiercely competive individual, and Winning is her top
priority. She wil say whatever she needs to say to win.
5
@Maggie, this ‘overly competitive’ rhetoric you are using is a typical sexist slander against at women in politics, and one that’s rarely levied against men. Men who are overly competitive usually win, and with great accolades.
Can you imagine Warren debating health care plans with Trump on prime time next fall?
3
As an award--winning economist with expertise in inequality and international economics, could Mr. Krugman please comment on how the following systems have been working for generations?
They are not 'aspirational', they are reality, widely supported by their citizens and parties. They cover all and spend less.
Why?
From True Cost Blog:
Country--- Start Date of Universal Health Care---System Type
Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier
United States 2014 Insurance Mandate
13
@Meredith
These countries spend less, because
they regulate how much Doctors,
Hospitals & Drugmakers can charge.
We don't.
And the big problem is not drug prices, which account for only about 15% of the nation's health care bill.
Our doctors and hospitals charge up to 3 times as much as providers for the Same Procedure.
And our results are no better.
8
Maybe they would not have to charge 3 times as much if they knew that there would be no more unpaid bills because their patients are broke.
9
@Maggie Mahar ...yes, important points. Krugman the economist could be writing about this....if many democracies don't have single payer, their insurance premium costs are regulated by elected govts, so people can afford them. Here that’s been too radical to talk about.
And he could give us comparisons of insurance company profits here vs in other democracies.
And drug prices are more regulated abroad.
They don’t depend on corporate mega donors to finance elections as the US does. They ban drug ads direct to consumers on their media, that we get 24/7. They think medicine is a doctor/patient matter, not marketed like any consumer product.
Many countries ban privately paid political ads on their media, so to prevent their campaigns being dominated by special interests. See Wikipedia.
Big ripple effects on their health and their democracy.
"if she wins big"... If she's the nominee, let's hope she does. Because to say "the system is rigged" over and over may sound whiny, but it is, and deliberately more so with the FEC vs United decision. Winning big--this would include defeating all 22 Republicans Senate seats up for re-election--would change this. How much are the Democrats willing to invest in this? It would take lots of new voters, and might possibly turn some gerrymandered districts to their advantage in the House.
4
@loveman0
Unfortunately, if Warren is the nominee, she could easiy lose.
She appeals only to well-educated white voters, a small slice of the population.
I agree that Warren met the challenge of showing how to pay for it, and I agree that it is still unlikely to pass. The public option seems like an appropriate transition, but fear that if we go that way, we might get stuck with it for two reasons.
First, how much will the public option be subsidized? Too much, it is expensive and private insurers can claim it's an unfair competition. Too little, it fails.
The second concern is that you know private insurers will work to game the system as if their lives depended on it, because they do. Private insurers will find a way to attract healthy customers and avoid less healthy ones. Whether it's by providing incentives healthier people want ("sign up and get a coupon for a bike trip") or discouraging unhealthy patients from signing up (our office is on the 3rd floor walk-up). So private insurers will argue they are more efficient than the public sector.
Not sure of the solution (other than a long transition in a Medicare for All plan to let people adjust), but we should at least be aware of the potential problems.
2
If we do go to a single buyer system, say just for drugs initially, how will Big Pharma respond? Do they want ts sell their products in the largest market in the world? If not, where will they sell them instead? Canada? Many or most Rx drugs sold here are already Made in USA. For those, If the Buyer allows a price that is lower, but still profitable, the larger market of 100% of people will increase volume, forcing them to ramp up production. They will still make good profits, but not with runaway prices and trick promotions through 'Coupon suppliers'.
Meanwhile, if doctors and hospitals, etc, are assured of being paid, they can cut support staff and have much lower overhead for billing and collections. They can focus instead on providing healthcare and wellness care, which can reduce future costs/patient.
7
I wish Warren plan had also shown the savings to individuals who will not pay under Warren plan the following:
(a) the insurance premium to their employ
(b) Copay
(c) Deductible
So even if middle class taxes go up, unless extra taxes exceed (a)+(b)+(c), people will be better off. Surprisingly, I don't see this in the debate. Rather than focus on taxes only, it is the net cash outflow that people should focus on. Under Warren plan, it will go down. The
messaging is very important here.
8
I believe federal workers have been on the "single pay" system administered by OPM for decades. Each fall the employee is given dozens of choices for medical coverage from companies that bid their lowest price to get subscriptions. This system is working.
With respect to implementation, just phase it in. Start Medicare immediately by dropping the age to 60 and offering it at 20. Move the ages down 5 from the top and up 5 from the bottom every 5 years.
Congress moves slowly and this might work, meeting in the middle.
4
Imagine what we might have today if Obama had led with this plan back in '08! Maybe not Medicare for All even under that scenario, but I think it's safe to say that at least we'd have a robust public option and much stronger cost controls. Warren understands it's much better to ask for the whole loaf and get half, than to ask for half and get a quarter. Kudos.
9
@CKathes
We wouldn't even have the ACA if Obama had led with this plan. He led with the public option and couldn't even get there, let's not kid ourselves.
Had Obama led with this plan, we would have exactly zero improvement in healthcare since 2008, since it would have been laughed out as something cooked up in the insane asylum. It's remarkable how short people's memories are - the public option (with the "death panels" that Sarah Palin claimed existed in the plan) was so radical at the time.
Do we need a single-payer system? Eventually, yes. Tying insurance to employers is one of the most boneheaded systems imaginable. But the American political system is built for incremental progress, and trying to accomplish it strikes me as impossible. As Krugman suggests is plausible, I'd rather a 2021 Democratic government pass a public option, let that sink in for a few years, and then move to single payer.
Is it ideal? No. But trying to pass the Warren plan means combatting insurers + the extremely wealthy and well-connected, and well...that's never going to happen.
7
If all the people currently employed, either by the private insurance companies, or by the doctors and hospitals, to handle the paperwork of processing health insurance claims, lose those jobs due to Medicare for All...how many people will be unemployed as a result of Warren’s Plan?
Just sayin’...
2
So we shouldn’t do something that is massively good for the whole population because some people would have to switch jobs? There will be many jobs created with Medicare for All, and she’s right in that the most qualified folks to get them are the people who worked at insurance companies.
3
I think this is why Klobuchar is the strongest against it. Minnesota is home to the largest insurer in the country. She fears people will have to change jobs.
She assumes those people are happy at their current jobs, the entire business model of which is denying patient’s medical insurance claims. It’s not a job I’d want! Who could sleep at night doing that?
How about those folks get priority in hiring working for the new system?
2
@Ann Maybe they will seek jobs that are actually productive then, and are not parasitic.
Senator Warren shows how capable and qualified she is for the role of President every day. She's trying to solve two of the toughest real issues we face, the uninsured and incredibly expensive healthcare costs.
We'll get a ton of savings with the single payer model, and much more if we force down prices to European levels; a hybrid German/French system is about 40% cheaper with comparable results.
Big, structural change! That's what will get the liberal voters to the polls, and we'll need every one.
19
@David Doney Big structural change that is so detached from reality will get many more people to the polls to vote against it than for it.
I am baffled to not be seeing this discussed, but what about the fact that any cost savings under Warren’s plan would go directly to corporations and employers and none to employees? If the employer pays for the insurance in full, they are also the only ones to reap the benefits of any savings. And is anyone under the illusion that most companies will use a reduction in costs to raise employee salaries rather than raise their profit margin? This is a corporate handout, to be blunt.
Let’s imagine that tomorrow we passed Medicare for all. You stop paying any premiums and your employer pays on your behalf to the government instead. They will offer lower salaries (or deductions) or let people go to cover the costs. The cost of healthcare will be the same at first and will drop over time as the government leverages its new negotiating power. Medicare taxes on corporations will drop. But nobody who knows anything about how businesses operate would think that these savings would result in raises for all their employees. Now let’s imagine that on day 1 of Medicare for all, as Warren’s plan seems to assume, the prices of pharmaceuticals and the salaries of medical professionals will drop precipitously all at once, sending the entire healthcare system into chaos. Costs will immediately be lower. Workers stop paying premiums, and employers make deductions from paychecks to cover increased healthcare expenses. They can just deduct what you paid for your premium and keep the difference.
1
Those same employees won’t pay premiums, deductibles and co-pays. Which amounts to a raise.
2
You must have missed the part about those insurance costs now being paid by companies being captured by the national plan under Warren’s plan. Paragraph 8.
Thank you, Mr. Krugman for saying this plan can work. Your voice has a lot of weight in this discussion - you have always been the financial sage we have confidence in. I've written to so many who doubt this will happen - well, why not? It's available in all the other first world countries in one form or another. I left the US for this very reason - and found SO many other reasons to stay in France, I will never go back. But this was the big push - almost 20 years ago!
8
We have a mix of public and private insurance in Australia. The government 'Medicare' deducts a percentage of your wage, the rest made up from general taxation. This covers you in public hospitals and most of your doctors' fees. You can nonetheless opt into a private fund. Many do, but they are increasingly unpopular (similar to the US funds): expensive, and you're still left out of pocket after an operation. However much I think the private funds are a ripoff & wouldn't belong to one (free public health facilities are excellent in this country) it's important to give people the choice of private if they want it. Not sure if Ms Warren's plan does that.
6
Question, Mr. Krugman: Out of dozens of capitalist democracies with generations of guaranteed HC, under varied systems, which ones have plans similar to Warrens? Compare/contrast/pros/cons. That would be an informative service for US voters.
Abroad, they're not all single payer. If insurance mandates, they have what we lack-- crucial regulations by elected govts, to keep premiums affordable for the majority. Is that too left wing to even discuss?
What are insurance profits like in other democracies with HC for all, vs in US? If Krugman, an award winning economist with expertise in inequality and international economies can’t give us that, who can?
Krugman wants to be 'pragmatic'---what can pass into law in our distorted politics. But who decides what's pragmatic? This is a life and death issue.
All the people in our main media bringing us the daily news and commentary on this hot issue have secure, good health insurance for their families that they can well afford. They don't want the left wing label. So, they carve out a middle road (objectivity). Less bashing by GOP/FOX News.
Voters need to know, from the candidates and the media-- what we spend on HC without Warren’s plan VS with it---to inform voters in this crucial election.
We need reality, not Reality TV media.
3
I’m sure there’s plenty of people who work in media that don’t have fantastic health benefits. Reporter isn’t really a well compensated position unless you are at the very top of the profession. I doubt the benefits are all that great
1
@Smilodon7 ....reporters/columnists who work for big media companies get good benefits. They are paid well, even if not the top salaries. Most employees at all levels of large corporations get HC benefits.
Remember that Medicare program as we now have it requires supplemental insurance if you really want anything close to full coverage. It also requires separate insurance either under a separate medicare plan or by separate insurance for drugs.
What is really good about Elizabeth Warren's plan is it is something to talk about when Congress gets someone in the Office of President that is willing to at least talk about it.
Remember how the Republicans wanted to repeal and replace, but would never discuss the replacement. They never really wanted to discuss that part of their plan and they still do not want to do it.
10
@Areader - Repeal and replace means Get Sick and Die.
1
@jahnay
That really is not very complicated.
Prof. Krugman’s assessment ends with the recommendation that Warren offer a public option, under which Americans who want tp participate in the Medicare for All plan can opt-in. In his view, this would resolve the opposition of those who want to retain their private coverage. I would suggest the mirror-image of this, in which Medicare for All is the default program, but those who wish to retain their private insurance could do so. Under this plan, the government would determine how much the public plan would cost per capita. For all those employees enrolled in the new program, employers would transfer that sum, multiplied by the number of employees, to the government to cover their premiums. For those who chose to stay in the company’s insurance coverage, the government would transfer an equal capitated sum back to the company to reimburse for coverage. If public and private coverage have identical premiums, nothing changes; but if private coverage costs more than the public plan, those employees exercising their choice would have to decide whether their choice was worth thousands of dollars more each year. I’m willing to bet that after a few years of paying this differential or watching their coworkers receive salary increases while their increases were being shunted to an insurance company, they might have second thoughts about the attraction of choice.
2
The is absolutely is snake oil. Even the Urban Institute, a left winged aligned "think tank" estimates the costs as $30 trillion. But Warren says it could be done for 33% less, at $20 trillion by "savings". That is nonsense. Operating plans tend to cost higher than the projections, instead it might cost $50 trillion if implemented. One can not reduce costs without seriously degrading service and quality, and the administrative costs with .gov handling medical care might even be higher than the private insurance companies that strive to streamline costs.
5
What? The USA ranks about 40th in life expectancy but spends much more per capita on healthcare versus all other developed countries. You doubt there are potential $savings in the USA healthcare system? They would be massive. What we pay fur prescription drugs and medical devices is at least 2X any other developed country and those countries have better life expectancies than us.
16
@Bascom Hill
Do you really think most Americans are wiling to see
their doctors' incomes--and their hospital's revenues--slashed by 20%, or more?
Drugs & devices account for less than 20% of our national
health care bill.
Doctors & hospitals are the big cost, and unfortuantely, patients believe that those that charge more are better.
Research published in U.S. medical journals shows that isn't true.
But try persuasing voters.
Even if we could, we can't just
suddenly slash specialist's incomes & hospital revenues.
Doctors would retire.
Hospitals would close.
If this is Warren's idea of
"big structural change" . . .
1
@sh
Warren's medicare of all, and much of her are other "plans" absolutely are snake oil. Cost only go up, not down. Doctors and hospitals cannot operate less for their services once pricing for the entire chain of costs have already been set - that includes equipment, building maintenance, nurse salaries, receptionist salaries, etc. And when one legitimately plans for a new project, they typically estimate that it will cost more than anticipated - that is real world financial planning. The exception is electronics and walmart stuff - and that is due to the Chinese discount. Medical care cant be implemented in that way. In Europe and elsewhere, they already established a lower cost health system from the beginning, no impossible reversal is required.
To Pat in Oregon how many people would lose jobs if we had Medicare for All I submit that the only jobs lost would be the CEOs and CFOs of private health insurance companies and their outrageous salaries would be saved.
All the claims processors and their supervisors would still have jobs to process claims, and there would be millions more claims to process if every American had insurance.
Therefore jobs are created with MFA.
The time/costs we now spend under private insurance having to call for pre authorizations and arguing with insurance company employees about whether a test or medication is covered would be saved for all involved on MFA. These people would still be employed processing the claims instead of denying the claims.
The flaw in the Medicare for All plans being presented is that they are being promoted as free. Now on Medicare we pay a premium for Part B and Part D (medications) and premium for supplemental insurance. Currently on Medicare we each pay premium based on our MAGI (income) on IRS form of 2 years previously called Income Related Monthly Adjustable Amount (IRMMA). There are 6 tiers of income with increasing premiums for higher earners. Maximum tier is for earners of $500-750,000. Doesn't cost millionaires or billionaires more.
Continue Medicare premiums - lower premiums for low earners (and subsidies for poorest people) and raise premiums for highest earners based on income. Combines Warren's wage tax on ultra rich and MFA.
WIN - WIN !
10
I am shocked that Mr. Krugman did not call out the "Paul Ryan plug" by Warren's trippling of her mystical wealth tax. He rightly accused Ryan of failing to be honest about his policies. He should do the same for Warren when she also fails to deliver.
6
I am a British Indian who worked as a Chief Financial Officer(Treasurer) in one of the country’s leading Cardiothoracic hospitals for several years. I therefore was able to see the impact of free medical care on the lives of patients who had the worry of money taken away from them, allowing them to concentrate on their medical situation. Believe me, it works wonders. As an ordinary patient in my daily life I could see again the calming effect of free primary care upon the lives of the less privileged such as the unemployed or older people who were excused even from paying the flat prescription charge fee. The situation in Western Europe is similar, resulting in a population which is freer in its mind from one of life’s main worries. During our tour of America as a delegate at a bilateral health event, my wife and I traveled from New York to Washington. It was a shattering revelation to us when the passengers who befriended us on our journey had in one voice shared their greatest fears about just falling ill. Talk of bankruptcy was on many lips, something we do not see in England or in Italy( my wife’s country) leaving us sobered up and glad to not be Americans. I am not qualified to dabble in the intricacies of the Warren and Sanders plans except to say that at a time when inequalities are stark, a recession around the corner it will not be too much to expect a bigger share from the large Corporations and the super rich. America needs to be at peace with itself.
30
@Lakshman Pardhanani Medicaid covers low-income people that would not be able to afford health care otherwise.
1
@kj In defense of Mr. Pardhanani, I fail to find any mention of Medicaid in his comment. And to suggest that the existence of Medicaid will prevent people from falling into bankruptcy, is being less than honest. Many who are not Medicaid patients find that any major medical procedure will wipe out their savings and leave them in the poorhouse or bankrupt, often because they have no health insurance whatsoever.
9
@Marcos Campos Thank you for your defence. Every citizen in the UK is entitled to free medical treatment. The middle classes do not go bankrupt and the less fortunate do not pay even the flat fee for drugs. The Tories have always attacked our NH S and we have lost 300 million pounds recently. They are of the same view as Trump!!
First of all, Warren adopts in full what services Medicare For ALL would provide in accordance with the Sanders plan. Her methods of payment are more detailed than Sanders but are in very much in agreement with Sanders menu of suggestions of how to pay for the plan. She adopts Sanders financial transaction tax and moves closer to the size of his wealth tax. Sanders did include modest taxes on the middle class, but only as a suggestion. Warren seems so intimidated by her political opponents and the press that there are no taxes on the top 10 to 2 % in earnings and wealth. Politically wise maybe, but why should those earning in the neighborhood
of 200000 and above not pay anything for health care costs.
It puzzles me why people like Krugman regard M4A as something that will not become a reality. If Warren or Sanders running on M4A as a major issue, defeat Trump in 2020 by a large margin, as currently predicted by the polls, it should become a reality and in short order, Otherwise, we need a new Democratic party.
Then Krugman shifts to climate change. Climate change is a much more difficult issue to tackle, It is a global issue. Its solution demands significant technical innovation, and most likely huge investments and costs that could meet resistance. Krugman seems to be echoing other columnists here - they seem to speak in one voice, Could it be their way of diverting from the imperative of creating a M4A system.
4
To allow heath insurers to operate nationally and to regulate them stringently would be Constitutional under the commerce clause.
Voluntary catastrophic medical coverage under social security would be eminently practical.
Indigent medical care should be left to the states.
3
Why? That would mean that the quality of care you get would still depend on your zip code. Isn’t that one of the problems we are trying to correct here?
Although I favor a voluntary buy-into-Medicare option rather than a mandated plan, I'm encouraged by the direction of the Democrats'/Warren's MFA discussion. It's estimated that eliminating the administrative burden of multiple insurers could cut approximately 20% of our health care costs; in contrast, single-payer Medicare's overhead is less than 5%. I'm also delighted to see that Warren has identified and will engage the biggest cost shift issue, what employers already contribute to their employees' health care premiums, and tagged it for off-setting the tax burden on regular-earnings families (requiring employers who are now offering health insurance to their employees to pay the cost of that insurance into MFA). I think the dual impact of administrative streamlining and employer contributions could very well bring the costs of MFA into an attractive, and likely better, range than we currently have.
9
Here's the difference between Democrats and the current batch of republicans:
We debate (argue) our issues and opinions vary greatly.
Republicans all go in lockstep. Like all publicly agreed tax cuts would pay for themselves.
14
Single-payer system with medical payment coverage mandated nationally will reduce administration cost because of one set of rules, but does not need to be run by the government.
If private insurance companies can service such a basic health plan (where premium is paid by the government) but also sell additional coverage (like more treatments not covered by the national plan), than you can more options and better policing of hospitals and clinics. Private insurance companies will make money on the additional policies and in return give better services.
In addition, HMO can sign up customers directly with the premium paid by the government, then more services can be included.
4
@paul
Reducing administrative costs
will not make U.S. healthcare nearly
as affordable as healthcare in
Europe, Canada, etc.
We pay our specialists & hospitals
3 times--or more--than providers would earn in Europe for the same procedure. And our outcomes are no better.
We also pay far more for drugs than patients in Europe. Warren would be willing to tackle that problem, but
drugs account for only 15% of
our naton's healthcare bill.
The big problem is that we pay providers far more & Medicare
reimburses them for overtreatmemt.
1
A $52 trillion government health care program. I don’t care how much pencil sharpening she does, this isn’t a law school class, it’s an election. The great majority of Americans would no sooner vote for that than they would vote to abolish Christmas. Can you say “four more years of Trump and the end of the republic”?
11
@Michael Hogan I would be very happy to abolish Christmas; speak for yourself
Why no talk of the huge, and trending higher, tort costs in the healthcare system? Also, no mention of personal responsibility, make people with risky lifestyles and behaviors pay more. Pricing for risk is eminently fair for controllable risk factors.
Warren is clueless about economic incentives, and the CFPB provides a good example. Her baby has hurt low income folks ability to gain access to credit and had nary an effect on the financially sophisticated.
3
I honestly don't understand the constraint that middle class taxes must not be raised one penny to pay for universal healthcare. As a middle class person myself, I'd gladly pay more tax if it got me out of paying medical insurance premiums, deductibles, and co-pays. Even if the total came out to be a little more. I'd be freed from worrying about in-network/out-of-network, confusing bills, preferred providers, and all the rest of the fun ways the insurance companies have devised to separate me from my money.
67
@Christopher Walker I think it is because of the $1Trillion tax cut over 10 years that was just given to corporations and the top 5%. Unless that is clawed back it is kind of silly to extract it from the middle class first.
2
Twenty trillion here, twenty trillion there, and pretty soon you are talking about real money .
Missing from this column is any reference to the costs of the twenty or so other Warren "plans" which she, thus far, has neglected to elucidate or put a price tag on.
I am afraid that Senator Warren is playing a great demagogic game ." Let me win the primaries, and then we'll talk seriously about what is possible ".
Does anyone remember Mitt Romney's Etch-a-Sketch speech ? Here it most likely is again, this time in its Democratic version .
8
"Even if Warren becomes president, and Dems take the Senate too, it’s very unlikely that Medicare for all will happen any time soon."
Thank you Dr. Krugman
But I still don't understand why you and others 'feel' that legislatively Medicare For All is unlikely. Given if your words above came to pass and the math is plausible it would seem a majority of the Public could be persuaded to favor a MFA program.
I have yet to hear any argument, other than a program affordbility one. Given our Defense Budget has been continually increasing while our capability (nuclear & technological) are supreme to every other nation. Defense contractor's wealth accumulation is what are tax dollars are defending.
Would an MFA degrade or decrease medical services for the Public? How? I am willing to be informed, educated & corrected on issues unfamiliar. I appreciate Sen. Warren's efforts to make us consider new possibilities and try to explain them.
6
Anyone with negotiating experience knows that you never expect your opening bid to be accepted. You ask a high price and make a low offer.
By making a serious case for Medicare for all, Warren has given us a good opportunity for a negotiation that results in a public option that is available to those who want it. I think she knows this.
14
Right after that meteor struck, eliminated the dinosaurs and got the mammals on their way to dominance, someone should have raised this question: "Why should a profit-making, multi-billion-dollar insurance company be involved in our health care?" It would have saved a lot of gouging.
17
@Paul Wertz yes and why has "competition" set us up that every supplier (equipment, drugs, etc) can enjoy huge mark ups with the US subsidizing the rest of the world who negotiates everything.
Insurance is high as it has to pay for the markups taken by everyone else.
I was an early Warren supporter and have been waiting for her to edge away from the Medicare for All Act's mandatory, 4-year framework. This was her last chance to do that, and instead she doubled down.
There is no reason to bet this election on a legislative pipe dream that will alienate voters and crowd out other urgent issues like climate change, when there are more realistic, less coercive, less disruptive pathways to the same end goal.
I will look for a more pragmatic candidate to vote for in the Democratic primaries.
16
@FB1848 Agree wholeheartedly. Regardless of the merits of this plan (which admittedly I have grave doubts about though I'm open to being convinced), politically it's an absolute non-starter for the moderates she'll need to win over to actually accomplish anything. Trump will make mincemeat out of her in the debates and we'll be stuck with four more years of the current chaos and undermining of the value of truth.
I'd vote for her (or almost anybody) over Trump, but the Dems have got to pick somebody more electable.
3
The Warren/Sanders plan doesn't seek to expand Medicare to everyone. It sets up a whole new system that goes far beyond Medicare. In fact, it has benefits that go far beyond those of any other country in the world. Other universal coverage countries all pay about 80% of the patient's costs. The other 20% is paid by the patient, or more often, supplemental insurance policy paid for by the patient's employer. Traditional Medicare does substantially the same. It has a monthly premium, various co-pays, and excluded care. Warren/Sanders pays all of everything. It also makes any kind of private insurance illegal, which will make many Americans who are covered by employer or union plans reject it. It would never pass Congress anytime soon, and it gives the Republican propaganda machine a lot to work with during the campaign.
I think that the AMA with a public option and other improvements has the best chance of becoming law. The AMA becoming law took almost a miracle, so it won't be easy.
Pete Buttigieg's Medicare For All Who Want It is a much better plan. It creates what is essentially a public option for those who want to join it, allows those with private insurance to stay on it if they want, improves medicaid, increases premium subsidies and has move improvements. If the public option can provide better coverage at less cost, as people like me think it would, people would migrate to the public plan. It would have at least a chance of becoming law.
14
@jas2200 “ Other universal coverage countries all pay about 80% of the patient's costs. The other 20% is paid by the patient, or more often, supplemental insurance policy paid for by the patient's employer”
That is simply not true.
4
@jas2200 Not true here in Canada. There are no billing departments in our hospitals , doctors offces or clinics. We do not pay for medical care except through our taxes.
3
@jas2200 "Other universal coverage countries all pay about 80% of the patient's costs." True here in Japan. We have a 20% copay, which I believe is on its way up to 30%.
2
How do gig economy workers, folks who work off the books, or part timers pay their share? Or does everyone else pick up their tab? I am currently over 65 and on Medicare. If I got a consulting gig doing my former job, the company that used my services would save on health insurance premiums vs paying a non Medicare person. Would this just incentivize more employers to have their employees classify as independent contractors in order to avoid the Medicare tax?
2
@Patrick politicians do not want to address these inconvenient truths and our incompetent media refuses to ask.
As mentioned in other threads please remember preexisting conditions as well as serious illness can wreck anyones life. Even those lucky enough to have employer paid plans. I personally know of instances where people in 'socialist' countries had serious medical conditions and did not have to fear becoming bankrupt.
8
I don't pretend to believe all Senator Warren's plans can come true in even eight years, but, she can make a good start. Currently I pay over $18,000 per year in Medicare taxes on my retirement and personal medical insurance to offset deductibles and prescription costs not covered by Medicare, possible Medicaid, and the retired military's TRICARE Program. It would certainly be beneficial to me and everyone in my position. Can it happen? Only if the House, the Senate, and the Presidency are fully under Liberal Democratic control for more than twelve years; an unlikely combination. But we can hope. Senator Warren has and will have my vote as long as she remains in the race. We, as a nation need her, her dreams, and her plans.
14
@Leia I'm noticing a lot of doubters are from Seattle. A once liberal city bought by numerous corporations.
Right now, about 15% of the U.S. workforce are employed in healthcare, and another 2% or so in pharma, biotech and drug distribution - thus bringing a total very close to the share of GDP going to healthcare. If Ms. Warren wants to reduce this expense it will involve either firing millions of people, or paying them meaningfully less.
7
@cobbler They can be retrained to work in Trump's revitalized coal industry.
1
@cobbler
none of those jobs go away. they are just all under an umbrella medicaire policy. it will cut out tons of red tape all these people deal with
2
If you’re going to make a public option, then make it so. Why keep the burden on employers? Most businesses are small-med size and are being buried by healthcare. Free up the people creating the jobs, or what’s the point. It’s just a redirection.
2
@Mike Cos I'm not American but I was under the impression if you guys get sick you can be booted off your insurance or have to begin paying more. This is never a concern in Australia under Medicare. How would that be a redirection? You're getting something you don't have: insurance you can't lose.
6
The people who argue against this tend to be the ones who are lucky enough that they haven’t had an insurance company screw them over yet. They love their private insurance because they haven’t really needed it for anything big yet.
Without getting into merits of give Krugman’s view that Warren has done enough to substantiate the economics of her plan, it does not mean that the electorate is going to be assuaged by it. Abolishing Obamacare and private health insurance in 2020 is a bad idea and could lose the Democrats the election. Warren has hitched her campaign to MFA and no matter how hard she tries to backtrack, it will be an albatross around her neck.
11
@TMAttorney When was the last time Paul Krugman was right on one of his "opinions"? I really can not remember.
Re a public option type plan versus medicare for all: Dr. K, that train left the station when the idea was pulled from the legislation early in the process that led to the Affordable Care Act. When will the moderate left learn that if you give up what you really want before you start, you won't even get close to half of it? I agree it's not likely that Elizabeth Warren's proposal will be passed in full but she is quite right to go for Medicare for All.
As a bonus, her proposals contain some tax reforms whose time has come, whether they are used to pay for Medicare or some other public benefits. In particular, I like the idea of a stock transaction tax - call it a sales tax. Where I live, there's a sales tax of 8% on many items and services and 4% on clothing, so why shouldn't stocks be subject to a sales tax of perhaps 0.1%? Considering that the dollar value of stocks traded annually is close to 3 times the GDP, this would raise a lot of money in a hurry while not even amounting to the noise in the fluctuating value of stocks.
22:45 EDT, 11/01
14
The fragmented and chaotic American healthcare has no “ system “ to be based upon , no specific medical rules and pricing nationwide , like in most European countries , where prescription drugs cost so much less , because foreign governments negotiate with Big Pharma the price of all life saving drugs .
In Europe our drugs come in packages directly from the factory , in blisters , with instructions and the name of the plant were the medicines were manufactured.
Most medical, surgical and diagnostic procedures in Europe have the same pricing nationwide .
In America at least 30cents on each $ spent is wasted in red tape , with insurances denying procedures or denying paying for docs or lab tests .
It is total chaos , providing mediocre care and denying treatments on bureaucratic basis .
Millions of Americans are famous for being uninsured and also underinsured ( junk health insurances ) .
We need anything related to healthcare out of Wall Street.
Every American must be provided with affordable and accessible health insurance and Americans must be educated that even in healthcare there is a lot of greed to perform unnecessary procedures .
I am fortunate enough to have yearly access to both the USA and European systems and I find myself more trustworthy about Europe , because there I am a patient ( not a bank account) , doctors are less aggressive in proposing surgeries and medications and the patient-doctor relation is at a human level without a chronometer shutting it off.
19
An earlier Professor Krugman NY Times healthcare article (Can Warren Escape the Medicare Trap?, Oct 21, 2019) had a comment from Marvant Duhon, Bloomington Indiana, who related that a tourist in the U.S. Senate gallery had suffered a heart attack, but was denied treatment from the on-station EMT crews by Senate Leader McConnell, because those EMT crews are reserved for U.S. Senators only [ https://www.nytimes.com/2019/10/21/opinion/warren-medicare-for-all.html#commentsContainer&permid=103225357:103226225].
I have tried to find an authoritative source for this incident, but have not yet succeeded. I am bringing this incident up again, because it is:
1. If correct, flat-out outrageous.
2. A solid cudgel to pound the hypocritical Republicans who have NO plan for improving health care for ALL Americans, but will fight savagely with blatant lies and distortions to thwart ANY health care plan that a President Warren would propose.
What is good for the goose is good for the gander. As an American ExPat in Japan, I am blessed with triple coverage for my health care - Japan's national health care plan, Tricare for Life, and Medicare (if I were to seek treatment in the U.S.). I fervently want my fellow Americans to have an equal level of health care coverage. Senator Warren is courageously proposing a plan to achieve that objective.
The Heartless Turtle should rue that day when he supposedly denied treatment to a fellow citizen in dire need of emergency care
10
How many paper-shuffling jobs would be eliminated? Every time I go to the doctor I am amazed at the number of office workers, mostly women. And those are just the ones I see. What about all of the employees at the health insurance companies? Whee will they go?
In addition to the where-will- the-money-come-from piece, we should think of the number of jobs that will be eliminated
4
A plan that eliminates several hundred thousand jobs, if not more, is red meat for the GOP. Krugman's defense is unconvincing and lacking specifics. Warren's plan is a recipe for Democratic defeat in 2020.
4
@pat same argument could be made to keep tobacco and opioid sales strong or any other activity which is wasteful, even harmful
5
Soo ... you're advocating keeping the current, extremely expensive and inefficient system solely on the strength that loads of people would lose their jobs if it was scrapped? In other words, you're not only quite happy to let the US public foot the bill for what is nothing less than a measure to keep the unemployment numbers down, but also gladly subject them to substandard, overpriced healthcare, which literally cost lives and leaves people in debt. Funny how people on the right, while screaming about socialism, are so happy to force others to spend their hard-earned money.
9
When employers are forced to pay the Treasury rather than the insurance companies, that money will be more likely than ever before to qualify as income, and thus be taxed. It's an idea some in power would certainly be eyeing if this ever comes to be.
Taxes will go up on the middle class, and it's foolish to think that can be stopped by a president named Warren.
2