One rational solution to the problem of ridiculously high health care costs would be to make pre-med, med school or dental school, internship and specialization free in return for accepting an obligation to practice for 10 or 15 years where needed. In our current system, a newly-minted MD is facing an astronomical debt on starting practice, and therefore must look for the highest-paying area in which to begin. The medical doctors among my ancestors sometimes accepted vegetables, fruits and canned goods in payment for their services. One cannot repay a high-six-figure debt with home-grown goods.
“Medicare for All” is the progressive version of Trump’s “Build the Wall.” Only in this case the wall is to keep out moderate swing voters and winnable Republicans.
“When Michigan sends their moderates to vote for us... they’re not sending their best...”
It's a huge risk when the number one objective is to beat Donald Trump, or in the event he's not the Republican nominee, his replacement.
After that is achieved only should we attempt anything that huge like Medicare for All. And that too with eliminating existing private health insurance, which most who have it are satisfied with it and would be quite apprehensive about giving up that comfort.
"Altogether, her campaign believes health spending under Medicare for all will cost $52 trillion over the next decade, with about half shifting from other sources onto the federal budget."
Where do you come up with that number? Even conservative think tanks put the 10 year cost at $35 trillion. And under our current system in 2017 it cost $3.5 trillion to provide health care and if you assume 5% inflation in health care that puts the 10 year cost at $43 trillion. How could a program with lower doctor and hospital reimbursements, a single uniform claim system, cost containment on prescription drugs, one party negotiating with medical providers, drug companies, etc. how could that cost $9 trillion MORE than doing nothing?
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If you think the current system works -- go price an unsubsidized Marketplace plan. Especially if you're in the age zone where you might want to retire early but aren't currently eligible for Medicare. Look at what the "affordable" plans cost -- and what they cover. You can do this right now, because it's enrollment season. If you aren't shocked, you are either rich enough not to care what things cost, or you are in some weird pocket of the country where health care costs are unusually low.
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A savings of $1.7 trillion for prescription drugs under a single payer system is substantial. Why wait? Enact free drugs for all immediately. Health insurance rates will go down, patients won't have to worry about copays, and even the uninsured will have some life saving benefits. I wonder why President Obama and Senator Sanders haven't thought of this. I mean how large could the political contributions from the drug companies be?
The other interesting part of the Warren plan is the 6% wealth tax to bring in $1 trillion over 10 years (up from 3% for billionaires). This is about the same as Donald Trump's 14.25% three-year wealth tax that was the major part of his political thinking when he wrote his book, The America We Deserve. Of course, Mr. Trump wanted to use the revenue to eliminate the national debt. It is at least they can agree on the need for a gigantic wealth tax even if they don't agree on where the money should be spent.
The real shame is that taxing wealth is a good idea, but only if there is inverse taxation of wealth and income. Let anyone who wants to pay a wealth tax get a big reduction on the income and payroll taxes. If you don't want to pay a wealth tax, you can pay the highest income tax rates with no tax expenditures. The idea is to give a break to the most productive as measured in their income to wealth ratio. Letting these people keep more of their income will increase their wealth and their productivity.
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I qualify for Medicare but I have chosen to stay under my husband's healthcare plan from work because of the cost of medications and the doughnut hole. I consulted SHINE (Serving Health Insurance Needs of Elders) and they determined that it would cost me less to only sign up for Medicare A. Medicare for all is not such a great thing if prices for medications are not brought down. When I lived in Germany we paid the most of any other European country for medications. In the US we pay even more than that. There needs to be a change NOW.
First of all why do we call it "Warren's Medicare for All"?
Second of course lobbyist for big insurance companies are going to say it can't be paid for...it would cut them out as the Middle person who is raking in all the money from Medicare to pay their bills and their enrollment agents. If people only realized how much are federal government is paying Medicare and now Medicaid private insurers for every person they enroll and yet they keep on denying coverages..
Medicare.Gov website changed this year just in time for Open Enrollment, actually forcing people to sign up for an account in order to actually correctly view plans and now puts their prescriptions in that account (which are with private plans)? and are actually touting Medicare Advantage as the save all..
Elizabeth Warren just took Bernie Sanders ideas and now touting it as hers ..come on.. Stop nickel and diming the process. Medicare For All, one plan, all prescriptions including dental land vision, should be offered to all. Since Medicare recipients pay a premium every month; it would shore up Medicare for everyone and Medicaid for everyone.
People need to stop listening to the "We can't afford this, and vote for their own healthcare...not someone's else's business profits!
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Sen. Warren must do a better job of explaining her plan and a roadmap how we are going to transition from a massive employer-provided health care to a single-payer Medicare for all. She needs to clarify one big point...we are already paying for health are, either through our employers or through private insurance plans/Obama Care. I imagine under her plan people would pay for Medicare for all, either through premiums similar to Medicare or private plans...this plan would save the 20% now going to pay for the administrative costs of private health plans...above all, a single payer plan would take away the industry incentives to keep hiking costs and premiums. Senator, Please do a better job of explaining your plans..or else you will be clobbered with stuff like Dealth Panels and Health Care Rationing.
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It's such an ambitious fantasy game.
1. It would require a massive upfront expenditure to set up the system. Think about the IT systems owned by all insurance providers combined. Otherwise, is it going to be a communist revolution when property of insurance companies and patient records get expropriated by the government?
2. It would incur a large human cost with people who work for insurance and claim processing losing jobs. It would require new skills and people who understand what they are doing (nobody does currently).
3. It assumes that businesses will not flee or find ways to pay taxes elsewhere.
4. It assumes that doctors and hospitals will be still available, don't retire, don't flee and accept this insurance.
5. It assumes that immigrants will come and stay. It also would need money to process those immigration applications.
6. It's a massive power and money grub by the federal government. Single payer (in Canada) works the other way, provincial governments receive federal money and manage the local healthcare systems.
In the end, admin costs would be as twice as high and the moneys collected as twice as little. Oops. The system doesn't allow any flexibility. But, I suspect, this "plan" is just a ruse and was never intended to work anyway. Bigger, better, cheaper, repeal-and-replace. Trump 2016.
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This article clearly illustrates why a trial period of Medicare for those that want it is essential instead of jumping into a full-blown MFA. Current Medicare programs charge premiums, have out of network doctors, don't cover vision or dental care and reimburse many procedures at rates too low for some providers, causing them to reject "any new Medicare patients." Adjusting for all of those plus the retooling of billing offices to serve millions of new users require time, analysis and thought that cannot be rushed.
Perhaps there are pieces of the existing ACA that could be melded into Medicare to improve it? Throwing the existing systems out without deliberation and trials would be a huge mistake. The US doesn't have just a batch of 5 million people like Norway has to cover - it has 350 million if all are included - an immense difference.
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Warren's plan is called "unrealistic', but what is really unrealistic is the current trajectory we are on. There is simply no way to rein in health care costs under the present fragmented, largely private system, which is full of rent-seeking, perverse incentives and waste. Nor is it easy to change health care delivery piecemeal, as some have proposed; because any reform can be gamed and neutralized by the parties that benefit from the status quo. Comprehensive change in a sector amounting to 17% of GDP will be a tall order, but the US has pulled off far heavier lifts, like the total transformation of the economy to fight WWII. But getting people to realize what is at stake will be much harder now than then. People content with their health insurance usually have not had it tested and are living under a false sense of security. Insecurity will grow as costs balloon over time and more and more of the burden is shifted back on to the consumer. The real weakness of Warren's plan is her iron clad commitment to never raise taxes on anyone but the rich. We can see why she takes this position, to pre-empt inevitable Republican attacks, But it because of this that she has to make so many forced and unrealistic assumptions about how her plan will save costs. She has boxed herself in. It would be better to say that taxes might have to go up for all of us, but that the final result, liberation from the current system, will be well worth it for the vast majority of Americans.
Opposition to implementing universal healthcare here in the US reminds me of something. Back in the 1970’s, Congress folded under lobby pressure and did not adopt the metric system as the standard of measurement - despite it being the standard in most industrial countries and all of science. The USA unions and factory owners claimed it would cost too much to re-tool, re-train, and would cost jobs.
Well, those factories were very soon gone anyway as the production was moved to other countries that had invested in brand new machinery, trained their workers and thrived.
What’s our health care situation going to be? Status quo - with the expensive, complex, inefficient insurance and health care industries we now support? Or at least as good as the other first world countries?
Not to mention that saddling our employers with the health insurance burden makes them less competitive in the global economy. No wonder they sent the factory jobs overseas!
The companies that produce drugs that have miraculously helped women with breast cancer, such as Herceptin, are designated persona non grata under Warren’s plan. Elizabeth Warren just does not understand what drug companies have invented and what it costs to do so
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@Kirk Does that include the ridiculous amount of money spent on TV ads? Somehow, drug companies invent things that cost less everywhere else but the U.S. and still, they stay in business. And how do you explain that the price of insulin has skyrocketed? Innovation? No, price gouging.
Wealth is a capital stock, that is it produces income. A tax on wealth must reduce that capital stock. There may be valid reasons to reduce the amount of private capital. Maybe President Warren can appoint specialists to make capital investments better than the private marketplace.
But it is unquestionably folly to imagine that a tax on capital can be used to support new consumption spending without impair the future economy.
It's like using the seed corn to bake treats to eat.
The real problem with medical care in the U.S. is not that doctors are paid too much, but there is far too much doing procedures and questionable treatments because a third party pays the bill. Warren's plan would cement rather than remedy the problem.
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Insurance is a disaster. We need a fix, and this is the best one available right now. There is room to save money-- medical care doesn't have to be the most expensive in the world in the U.S. For example, the average doctors makes about 250k a year. Professors need even more education-- PhD's take about 5-6 years, plus 2-4 years for a post-doc, and they make 70-120k. I think if doctors only made 175k a year, they'd be OK.
It is short-sighted to think that $175k is a reasonable salary for a physician. Not only will the best no longer choose medicine as a career, but current providers will leave in droves for other careers in the corporate world. When medical school costs 300-500k and take 6-8 years of grueling training beyond undergraduate education, why would anyone choose such a career? A bachelors degrees and job in technical sales pays more than $175k, with minimal student loan debt and 8 years of additional earning potential.
Everyone wants to see the best and the brightest when they go to the doctor and low salaries won’t get it done.
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I am open to the idea of medicare for all, but am more comfortable with a public option. The biggest reason I am for the latter is because I have yet to be convinced that it can be payed for in any realistic way. This plan as presented by Warren has no wiggle room at all. What happens to her plan if drug prices do not fall as fast as she predicts, or casts continue to grow faster than the rate of GDP, or if her immigration overhaul plan does not pass? How would such unforeseen, but certainly possible, scenarios affect the funding for her medicare for all system? There is no flexibility in this plan and it assumes everything will roll out perfectly, which they never do.
1
A couple months ago President Trump
Announced intent to push for more availability of dialysis therapy for End Stage Renal Disease patients.
That may raise or lower costs, but was premised on better patient service and quality of life concerns!
WELL, Guess What?
The ESRD coverage was made available any US Citizen needing such therapy Autumn 1973
In a Medicare Laws revision and was signed into Law by President Richard M Nixon!!
Universal coverage for all Citizens, guaranteed by Medicare and US Government!!
Certainly sounds like Universal Medicare for kidneys is a fine precedent for whole body medicare coverage.
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Without swift and robust action on climate change we won't be able to afford health care for all no matter what the mechanism.
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It takes three decades for carbon gases to cycle in and out of the atmosphere. Can you do without affordable health care for three decades?
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My great concern is that the Democratic presidential candidates are competing to see who can make the most woke and socialist promises:
Free college tuition. Medicare for all, including illegal immigrants. College loan forgiveness. Reparations for blacks and gays. Guaranteed basic income. Federal job guarantees. Federally mandated school busing to achieve integration. Green New Deal (eco-socialism). Voting and early release for prisoners. Open borders.
All the fabulously wealthy US individuals and corporations together do not have the many trillions of dollars needed to pay for these goodies year after year, and even Bernie Sanders has admitted that taxes would have to be raised on the middle class to pay for Medicare for All, not to mention the additional trillions needed for the other items. (For perspective, the current US budget is about $4.4 trillion, with a deficit of about $1 trillion.)
As Margaret Thatcher aptly noted, the problem with socialism is that sooner or later you run out of other people’s money.
Don’t forget that our goal in 2020 is to elect a Democratic president, and that will require appealing to the independents, undecideds and others whom the Democrats failed to reach in 2016.
If all of these progressive (socialist) promises, or even a few, are planks in the 2020 Democratic platform we are doomed to a second term of Trump as president.
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@Mon Ray I don't understand why progressive tax policy is labeled "socialist." We have a crumbling infrastructure. Our students are coming out with debt that they will carry for decades as a price of getting a "good-paying" job. Climate change is the single biggest issue we've had to deal with, which touches every other issue.
The wealth of the country is held by a few people. All of these existential issues to resolve. Who else should be held responsible for ensuring we even have a Republic moving forward, besides the wealthy?
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@JP who else should be held responsible? It’s going to be you and me, JP.
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@Mon Ray Mon Ray claims that "All the fabulously wealthy US individuals and corporations together do not have the many trillions of dollars needed to pay for these goodies year after year..."
Think again. We are the only developed nation on earth that saddles its college students with overwhelming debt; we are the only developed nation on earth that foists for-profit health insurance on its people, double what it costs the citizens of any other country; European countries are far advanced in implementing the tenets of the Green New Deal.
Look at Denmark, France, Germany, Britain, the Netherlands, Canada. They're all doing what you are telling us America is incapable of doing.
We can, and we will.
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We need to start holding journalists responsible for describing dollar figures that are comparable. The authors state that Warren's plan costs $52T over 10 years. What does Biden's plan cost? What does the current system cost with health care costs rising far faster than inflation for as many years back as you care to look. Thats what we need to know and journalists should write these controversial articles in a way that makes this comparison clear.
This math is absolutely wrong. It does not subtract the tax we are currently paying to the insurance kleptocrats.
I am no fan of EW for her other policies but give her huge credit for laying out her plan in detail, and at least trying to fix our current messed up system of haves and have nots. She wasn't lying when she said middle class folks wouldn't see tax increases. They'll actually get a large raise. Smart to do that since everyone knows a government run system will have many problems associated with it, and the haves won't have the system they're used to. Smart to give everyone what will be a significant wage increase in order to counter that legitimate criticism. Her tax scheme will cause some damage to the overall economy but she is trying to minimize that with the approaches she uses to suck money from the obscenely rich first and foremost or tax loopholes that shouldn't be there in the first place. I don't think a return to the 35% corporate rate will be good for jobs however. Need to be competitive with the EU rates
Why can’t we take it slowly, work on one health care problem at a time, keep working on it until all the kinks are out, and when that problem is solved move on to the next one? For instance, why don’t we start with the high cost of prescriptions? Why not find ways to cut costs but still encourage big pharma to keep researching and developing the many miraculous drugs and treatments that are saving countless lives.
In my opinion, this plan is way too ambitious and will upend not only our health care but also our economy. Let’s get it done, but let’s do it slowly and sensibly, one step at a time.
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@Anne Because in 30 years of government trying to "fix" healthcare, it's never been about fixing healthcare. Some in government want to control the trillions spent annually on healthcare, if they need to destroy our system in the process so be it.
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@Anne Other countries control prescription drug prices by negotiating with them as a single-buyer. What's the next healthcare problem you have in mind that single-payer directly addresses?
We are the wealthiest country in the world, of course we can pay for it like the rest of the world already does. Medicare for all is the only way to control the cost gouging that has made our healthcare the most expensive in the world. Don't let the trolls scare you Medicare for all is good for america.
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@plamb We are not the wealthiest country in the world.
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@plamb Medicare is the most expensive plan in the world, how has it ever controlled cost?
Once again, we're given only one side of the equation: the spending part. What are the savings? Tell us how much less the average American will pay for healthcare. Tell us what our expenditures will be over the next decade under Warren's plan, versus the projection of healthcare expenditures under the current projection.
What is the bottom line for savings? Simple question.
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@Sean
I agree we're only given one part of the equation: where is the GOP health care plan? Still only for congress and the ultra rich?
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@Sean
Under Warren's plan you pay nothing for healthcare. There are no premiums, no deductibles, no copays, no coinsurance. And most things are covered. If you are not in the top 1% of income earners and not a billionaire or a big investor, you also will pay no more in taxes.
So whatever you pay now in premiums, deductibles, etc. is what you save.
10
@Sean Simple math .. How much do you pay each month in health care premiums .. Which likely are taken out of your payroll check by your employer .. Add that to your take-home (minus state-local-federal taxes) .. Bingo
5
The Progressives are all wet. The moderate Democrats are correct. We need to have something like the ACA with a public option. Medicare for all would be very destructive to medical services in this country. Doctors and hospitals would revolt. Hospitals will close and Doctors will leave the health business.
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@NOTATE REDMOND You are 100% correct. Now if only the parties that create these pie in the sky proposals would listen.
1
@NOTATE REDMOND
Do you think all doctors will leave the health business? Does this mean they are in this “business” merely for profits, or might some also be dedicated to helping other people?
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@NOTATE REDMOND That is a benefit for their plan not a negative. Their plan can never deliver what it promises, their has to be rationing. The easiest form of rationing and the one they would get the least blame for is a shortage of supply.
1
I would rather pay higher tax that covers my health care needs than being charged arms and legs when I get sick. Right now my health insurance does not cover an ambulance transport. You should not have to contemplate whether you can afford a ride on ambulance during the emergency.
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@peakfinder Do you have stocks at all or a 401k? As those grow I’d be afraid my reinvestment would disappear because my stock is getting taxed even without me withdrawing anything or seeing a penny of it. That doesn’t seem fair at all.
2
What people are completely missing in this discussion is that we, the people, already pay for the entirety of health care costs for ourselves. We pay monthly fees, we pay deductibles, we pay co-payments, and we pay social security and medicare taxes. But we also take as a benefit what our companies pay on our behalf to provide us with insurance.
The current way of paying for it leaves a lot of room for profit incentives, and administrative overhead.
This is what Warren is confronting head-on.
If a central payer can consolidate all of this spending, and has an interest in wringing efficiencies out of it, then we might be fortunate enough to end up with universal coverage that costs less than what we're paying today, which is usually for shoddy coverage, and which continues to snare people in bankruptcy, and continues to make insurance companies extremely wealthy.
In short, if we move in the direction Warren has outlined, we might possibly join the large group of "advanced" countries that have already solved this problem at far lower cost than ours.
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@Incontinental I agree. Everyone talks about the costs of what a single payer system would cost but they never seem to compare it to what we are currently paying to insurers.
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@Mine2
You are assuming that govt will do the right thing and administer single payer in an efficient manner. Democrats and Republicans can't even talk civilly currently because both parties are doing their best to gain control in Washington. If you think politicians are there to help you, no matter the ideology, you are sadly mistaken. I know, I work for a politician.
2
Oh, you mean like the US Postal Service or the VA or the public school system. All examples of gov’t run programs.
No thanks
2
I have read many comments n this thread and the degree of fear most commenters have toward much needed change is sad and disheartening. We have lived in an abusive, predatory health care system for so long now it is as if the commenters are so used to the abuse they would rather have that than a system that will cause a great deal less pain and suffering all around. So what if it takes a little while to tweak the mechanics of it. That's the nature of change. But it is for the better, especially for our children and grandchildren. And under Warren or Sanders, we are in good trusting hands.
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@Laura Philips
I have been reading that most do want change.
They simply want to do it differently than Warren, like with a buy-in proposal or what Buiitigieg calls medicare for all who want it.
It is not change that they are afraid of - at all.
They welcome it.
What they are afraid of is that such a massive, all at once, and hugely expensive proposal like M4A will lose her the election in the swing states.
And for what?
Even if she did win, the odds that she would be able to implement this proposal is very remote. It is far more likely that she will be be signing the moderates' proposal for a buy-in into law instead.
So, since the moderates proposal polls well, can get done, and is a proposal one can win on in the general election, so why run on M4A?
It makes no real logical sense.
Because of climate change, we can't afford 4 more years of Trump.
No risk of losing is worth it, especially an unnecessary one like M4A, since he buy-in proposal will get us where we need to go and can win a general election.
Nothing gets done if we do not win.
9
This let-it-rip approach is foolhardy in the extreme. Simply lower the eligibility age for Medicare by two years each year and people can choose to sign up or not. In twenty years, the problem is solved. Or, if not, we could learn that gradually and adjust as necessary.
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Add to that letting anyone who is currently employed (or in between jobs) without healthcare to jump on board and you’ll get closer quicker.
2
How you will pay for that, considering that you are missing healthy population in the pool?
3
The math at this point is basically irrelevant, because this plan is dead in the water. What I miss with any plan of single payer healt care is how to logistically and legislatively get there - against the will of a 600 billion dollar health industry and ca. 1.3 trillion dollar pharmaceutical industry. Warren's idealogy in my view is not at all radical, it is perfectly logical, but the idea of running a campaign on something that is virtually impossible to achieve is troubling to say the least. Obama often said that he would PREFER a single payer public system, if he could START OVER - this was sensible - Warren should express more humility and admit that her plan is merely theoretical, and in reality, there would have to be hundreds of steps, climbed over many years before the US could have such a health-care system. In the meant time, the focus should be on driving costs down and getting people insured, one way or another.
3
Regardless of cost for Elizabeth Warren's plans to implement Medicare- for-all, what I know is many nations around the world, including Canada, provide health care to their citizens at about half the cost of our health care costs and many of these nations provide better medical outcomes. It's reported administrative cost for Medicare are significantly less costly for Medicare than for for-profit medical insurance. For all of the argument that the Medicare-for-all plans are too expensive, please explain to me how most other nation do this but we, the richest nation in the world, CAN'T.
4
@Bob Ellis Because they aren't inviting the entire world to enter their country with open borders.
1
Impressive plan. Let’s call it what it is: A Blueprint for a Buttigieg Presidency (or perhaps, for the sake of alliteration, you prefer another moderate Democrat whose name starts with a “B”)
1
Why not legalize marijuana in all 50 states and tax the heck out of it...there’s your Medicare for all money.
@Marie Because we would have many more people sitting around doing drugs all day and not working. We already have too much of that.
In the USA you work like two people get old and sick and they take it all back. At the hospital they x ray your wallet first. I know I know Americas are the smartest people on the face of the earth why would they give up paying threw the nose.
1
I heard a clip of Joe Biden saying: "she is just guessing, it is more like 30 to 40 trillion" referring to Warren's plan. Shame on you Joe. What is your plan Joe? What numbers did you crunch Joe?
2
The math assumes the rich won't move. This is questionable.
From the Guardian , 2 days agp
"Super-rich prepare to leave UK 'within minutes' if Labour wins election. Wealthy see potential taxes imposed by Jeremy Corbyn as bigger threat than Brexit"
"Hargreaves said the stockbroker employed about 1,700 people and had “created a vast amount of wealth for this country”.
He added: “If you create a tax regime that is not going to welcome and support people like me who create wealth then you are going to rapidly reduce the health of your economy.”
Hargreaves said he paid about £40m in tax last year, and “if 50 of us [the biggest taxpayers] got on a plane and left, that would put a big hole in the chancellor’s budget”.
https://www.theguardian.com/news/2019/nov/02/super-rich-leave-uk-labour-election-win-jeremy-corbyn-wealth-taxes
Could this happen . If the past is a guide to the future : Yes
When , in France, Hollande tried to tax the rich at 75%, the rich moved. The tax failed
In a global wold the rich can live just as comfortably in London as in NY, in Paris as in SF - or even Shanghai
https://www.bbc.com/news/world-europe-20921208
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@Woof That's a pretty tired talking point. You hear the threats, but no significant number actually move...even if they wanted to, a service economy isn't exactly portable. Amazon warehouses can't go anywhere. Oil fields can't move. Are they going to move to another country with Univeral healthcare? Every major country already has it.
If this thing is implemented...no one has even begun to explain if or how the current Medicare fee schedules will be adjusted to ensure that our hospitals have enough money to keep their doors open. Currently, Medicare has a set fee schedule for everything. This fee schedule does not cover the actual cost of providing care. So, the prices for those with commercial insurance are elevated and are used to subsidize the Medicare population. Do the cost estimates take this into account?
This IS NOT propaganda. Please do not take my word for it. You are more than welcome to do a quick internet search on Medicare fee schedule to see for yourself.
1
@Lyn Robins
Wrong Lyn, the retail prices quoted for services are only paid by the uninsured. Commercial insurance companies negotiate downward from those prices. Ask anybody with Blue Cross to show you a bill, which will show the amount billed at the hospital, and the amount the insurance company pays.
Our health care costs are inflated in several ways, one of which is dealing with hundreds of insurance companies, all of whom make a profit, pay salaries, advertise and put on seminars for physicians. None of that gets service one to any person with an illness.
Look at it this way. we have the most free market system in the world, and we pay half again what anyone else in the world pays.
We'd be hard pressed to be so stupid that a national health care system does not SAVE us hundreds of billions of dollars a year to address real needs.
1
My concern, is that like Obama's ACA the press is not presenting the issue honestly or comprehensibly. The press is happy to report unending conflict rather than do the hard work of laying out the facts.
What we read in large part is nonsense, nothing has been nailed down. What we have, is a giant blank slate.
So it stands to reason we dissect the programs our peer nations have had in place for decades. Simultaneously we can work to eliminate the lies, misdirection, and stupidity.
Hear that news gathering organizations?
Call out the misrepresentations, and name the people making them.
Because right now what this subscriber sees is the NYTs targeting Elizabeth Warren both in editorial and in its photo selection. Check it out, photos of Sanders and Warren are never neutral, always appearing crazy, deluded, and so forth.
1
Liz Warren is looney - tunes if she really thinks taxes will not go up. Also, name one Government run agency that is as efficient as any private run company.
1
@G G
Medicae, G G... check it out.
@G G In Canada administration is 5% of the total cost of health care. In the USA administration is 25% of the total cost. Government wins by 5-fold! Maybe its the $1.75B in salary (thats a 'B', $250M/year for 7 years) a former United Health Care CEO earned over 7 years...until he had to return $400M of it due to fraud (no jail time of course) (William McGuire, look it up!). Maybe its the large department maintained by private health insurance to reject care and then your doctor fights back and then the private insurance company fights back....back and forth a bunch of times...it all adds cost. In the USA health care costs about $10,000 per capita. So administration is about $2,500 per capita. We could save $2,000 per every single person, per year, if we could reduce our administration costs to what Canada's are.
1
This is her “let’s build a wall and make Mexico pay for it moment”
This is truly irresponsible of her
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@Joseph columbo
As to my later post, answer my question, Joseph. Why can many other nations provide health care to their citizens at about half our cost and with better outcomes and, as one of the richest nations in the world, we can't do the same ?
1
Can't we just call it for what it is? A Great Big Lie.
Well all I can say is get ready for another 4 years of trump.
2
Ya think it'll work better than it did in Vermont?
3
Who picks up the cost of underfunded government retiree health plans?
2
On the revenue side
-what about employers like Walmart whose Employee Healthcare Plans are a joke. Can’t get blood out of a stone. Scratch those trillions.
-State and local governments would have to raise salaries to private sector levels = tax increases.
-Amazon, Apple, etc. currently pay no taxes. The entire tax code would have to be changed first. Put that $2.9trillion on hold. Similarly for new new capital gains annualized taxation,. Scratch further $2trillion.
-$800billion stock transaction fees.? Are there any infrastructure investments in a Warren administration, because it seems like this and the rest of the list is really scraping the bottom of the barrel, every last dreg, IRS enforcement, legalized immigrant income taxes, Pentagon spending and new bank risk fees. all just to pay for MFA.
How will the rest of it get paid for, free college tuition, college loan forgiveness. Maybe a new legalized marijuana tax? No, no, not that!
2
This is insane. Bottom line is there is no one who is tagged as a payer who is willing to assume this cost. Voting for warren is a vote to massively change the definition of capitalism. Are we knowledgeable enough about the 2nd and 3rd order effects to make this journey?
6
The practical question isn't whether this is economically viable, but whether it's politically feasible. Not to put too fine a point to it, but it seems necessary to ask, in the face of all the entrenched powerful cartels at play and their fearmongering, propaganda and lobbying prowess, how do you sell "Communism!" to a fearful and cowed electorate?
2
So Ms Warren’s plan will cost 52 trillion over ten years. Could your articles please inform us of the cost WITHOUT Ms. Warren’s plan in place — that is, if things continue as they are— in order to give her proposed cost some real meaning ! If projected costs without are, say, 50 trillion, and quality is finally as high and stressless as in countries like France, Canada, Germany …, then her plan is a bargain.
2
@Frank
Warren's plan also says that under the current system projected costs are about $52 trillion. If you take the current cost of $3.5 trillion per year and increase it at 6% per year (the current medical inflation trend) it indeeds adds up to $52 trillion. There are some details about what's included as a medical expense (both in the current $3.5 trillion cost and in the costs included in Warren's projections) but it seems like she's assuming total costs are roughly the same no matter which approach we take. The difference with her approach is that more of the cost is paid by the wealthy and corporations in increased taxes, and therefore middle class and poorer Americans pay much, much less (as well as gaining guaranteed coverage). It's more a cost-redistribution plan than a cost-savings plan. But that's okay. Let's make what we're currently spending affordable to the working classes. Then let's address cost control more aggressively.
1
A really bad slogan. People can't even conceive a 20 trillion dollar plan. Since Warren and the Democrats would be abandoning Obamacare, the Republicans will advance Trumpcare, which for an easy monthly payment of $99.99 will get you perfect health care.
2
I believe the progressive wings insistence on medicare is not only a political loser but a pointless argument. Other "socialist" countries achieve universal healthcare through various means. Switzerland has an an essentially Obamacare on steroids and STILL spends less per person than we do. The point Warren should be making is that—we spend more for less. It's a pragmatic but powerful argument. Why some democrats believe that medicare for all is the ONLY solution appears to me born out of self-righteousness and ignorance.Warren should no better than most that there is many ways to skin this cat. Siding with an unpopular political solution is both futile an anti-productive to achieving the ultimate goal of insuring every American has affordable and quality healthcare.
4
@Paul
Single payer is a solution. There are other solutions more in line with the various continental European solutions that rely on compulsory, highly regulated, highly subsidized, and often not-for-profit private plans. These could work, but they also require a fairly significant reshuffling of the industry, a lot more government funding, and far more regulation and compulsion than Americans tend to tolerate. So they are challenging to implement too—and they are all likely more complex for the participants than Canadian-style single payer.
The widely touted "public option"—at least as I've seen in proposed (most proposals from the candidates are sketchy)—seems to be merely a Medicare buy-in program. This is a tweak to the ACA that may produce some marginal improvement in getting more of the uninsured and the underinsured more adequately covered. But it doesn't address the growing affordability problems of employer-sponsored insurance; and I'm not sure it does much to make insurance all that more affordable for the majority of those who are get their insurance from sources other than an employer plan. It's a tweak on the current system, not a transformative change, and therefore fails to solve many of the current system's fundamental problems.
Her funding plan is so off the mark. In what country is universal healthcare funding only by the rich? It's paid for by taxes that EVERYONE pays. Like a VAT. In Canada almost everyone pays taxes for healthcare even the low earners. We Americans foolishly think that there is enough money from the rich to fund this. Her numbers are also way off in almost every category. Unlike Bernie she does not have the guts to tell the truth about this and most Americans can't do basic math. If you believe her numbers I have a bridge in Brooklyn I'll sell you.
8
@Sarah99 Administrative cost of health care in Canada is 5%, in the USA it is 25%. Huge savings right there. Of the $10,000 per capita cost in health care in the US we could save $2,000 per person per year if we reduce the administrative cost to what Canada's is. If you can't do that math, i have a bridge in Brooklyn i'll sell you.
@Sarah99
I think she's showing a way the plan could be funded without raising taxes on the middle classes and poor. I think she's succeeded at that. If we do go to single payer will we in fact end up raising taxes on everyone? Quite possibly, but the savings in premiums and out-of-pocket costs will, for most people, still greatly reduce overall cost. The nice thing about her plan which doesn't currently require middle class taxes is that it leaves some money still available to us through those taxes if we end up needing it to balance the books.
JFK stated it a long time ago but I was old enough to hear him & to know it still applies today, maybe even more so, “Ask not what your country can do for you, ask what you can do for your country.” Most Americans live a very blessed life, a few minority groups & those born with or contract health problems being the major exceptions.
I do hope that we can look in our clear mirrors & ask, “What can I do to help make America a better place for all American people as well as a better world example.”
We become dependent on govt stipends, in some form or other, all too often. We become prisoners of our vices, we become obese in our refusals to just even walk more, we watch so much TV, A&E that we never have time to read nonfiction books & few real news media.
We become so laconic that we don’t want to even do the mental exercise of reading the news for ourselves, we let others tell us what we are seeing & hearing thereby allowing them to make Pavlovian dogs of us. In the back of our minds, we know that they are lying but, through habit, we have learned to like how they say things &, even though we know that they are lying, we still buy into it.
My Fellow Americans, Get Woke, take control of your lives & our govt so that we can leave a healthy planet for our children as well as having a good life as we do so.
Senator Warren 2020 is trying hard to give us some guides to that but joining her is up to us.
Vote for whoever you think is best but don't sell out our kid’s future.
1
@WorldPeace. Warren's plan is the antithesis of “Ask not what your country can do for you, ask what you can do for your country.”
Her entire campaign is about ask what your country can do for you, on the backs of someone else's labor.
COMPASSION CAREFUL COMPUTATIONS COURAGE = THE WARREN PLAN.
Way to go, Elizabeth! Time to run circles around Trump's bluster and bigotry.
1
I will only vote for the candidate who supports Medicare for All. This is a life and death issue for me. I every other first world nation on earth can provide free health care so can the USA.
Or we could let anyone opt into Medicaid and not destroy our health care system.
1
Call it the rise and fall of Warren.
The numbers never did add up.
This leftist ideologue is incapable of telling the truth when it comes to paying for her pie in the sky multi-trillion dollar give aways.
No wonder Mayor Pete is within a few points of destroying her in Iowa and becoming our next and best president.
Stay tuned to the next debate when he will eviscerate her.
5
When ever government becomes too bloated- the ever-increasing spending on public education, without concrete results or the growing personal and corporate welfare- America will come to resemble either the decaying Soviet Union or the dying Roman Empire.
It's certainly a job creator. All of these items are going to require a small army of bureaucrats to administer and enforce them.
2
The health care industry handed Hillary Clinton her lunch when she tried to spearhead health care “reform” in the 1990s. Obama made a Faustian bargain to achieve the Affirdable Healthcare Act. Warren’s Medicare for All will make that trifecta complete.
I first registered to vote as a Democrat, shifted to independent and then, when Ronald Reagan was elected president, I changed back to Democrat because I was so utterly disgusted with what his brand of conservatism did to this country. I have voted Democratic for president since Carter — and I will again in 2020, regardless of whomever is the Democratic nominee — but I am now convinced it will be an exercise in futility.
1
I would like to support Warren's candidacy, but this proposal reeks of bad faith. She committed her campaign to Medicare for All without figuring out how it would be financed (which is crazy in itself). This set up a circumstance in which there was an imperative to come up with numbers that appeared to add up, based on scenarios that are unlikely at best.
The result is a policy proposal that 1) isn't economically feasible, and 2) is easy to demagogue. The "Warren Wants to Take Away Your Healthcare" ads write themselves.
2
I love that she proposes the gain in the value of one's investments should be taxed. Does that mean when the value of your investments goes down you get the money back?
3
One thing is certain: if Elizabeth Warren becomes the Democratic candidate, Trump will get re-elected for 4 more years, and the country will fundamentally change in just the opposite direction to what she wants to do. The Democrats are headed to self-destruction.
4
Nobody can evaluate any of these proposals because:
1. They do not say what they will pay for
2. They do not say what they will not pay for
3. They do not say how much they will pay
We should not cover everything medicare currently pays for. Medicare has no utilization review- the thing people hate, because they sometimes deny procedures. I hate talking to insurance companies, but they are usually right about what is useless, and I have never had them deny something truly necessary once I make the phone call. Patients may not like the answer, but you do not always need that MRI. In fact, you rarely do.
We also cannot afford to continue with fruitless end of life care. Nor can we continue with a large portion of the population working off the books and not contributing anything to the pot.
We also need to know what I will be paid. Because if it is a big reduction, I promise that you will be hard pressed to find a doctor willing to do things on your schedule.
3
The unfortunate thing for the country is that Warren in her personal demeanor and temperament comes across to the general electorate as a left wing
bomb thrower on the verge of a nervous breakdown. People who have already paid very dearly for their own current medicare insurance premiums and/or their employment provided medical insurance,
are not going to vote for medicare for all. Ditto voters who paid their own way through college and/or have diligently paid off their college debts are not going to vote for the taxpayers to pay off other people's college loans. Similarly, millions of voters who pay capital gains taxes will not vote for increasing the tax rate on their own capital gains.
2
Warren has a knack for making everything free. When someone gives you something of great value for free, be very skeptical about what you're getting.
2
Ms Warren would do well to push for pot legalization, or at least get it off the schedule 1 list. The feds could take a percentage of the taxes put it into the Medicare Fund. Legalize sports betting every where that wants it and use some of those taxes. Even look at legalizing the sex industry. Lots of money there, plus other saner benefits.... The point is, look for money where it will do the least ' raising taxes ' harm. Some here , some there, pretty soon it starts adding up.
1
Healthcare is security. We spend trillions on hypothetical military security based ventures which actually make us more vulnerable. Healthcare directly ensures each American is safe from almost unlimited real threats to our livelihood. For example l, cancer is a much more likely threat to your life than terrorism.
2
I cannot support any Medicare for All plan that will BAN all private insurance. How can Govt. ban a business that is legal in all countries with nationalized healthcare like Canada & UK?
So if the treatment recommended by my doctor is not approved by medicare then I am forced to suffer my condition? This wi not fly with voters and will easily be exploited by Republicans.
2
From a strictly political standpoint, Warren’s decision to unwrap these massive tax and healthcare policy proposals may have doomed her in the general election, and may hurt whoever the Democratic candidate is, if it’s not her.
She is naive, misguided, or simply politically tone-deaf if she thinks voters have the interest or ability to absorb and understand these highly complex proposals in the midst of a campaign.
Instead, she (and her party) will be demagogued into oblivion with easy to understand attacks 24/7.
Trump is beatable, but proposing a giant re-shaping of the US economy is DOA, akin to O’Rourke saying that he was, in fact, coming for your guns.
This election is not about policy proposals that turn life upside down, create uncertainty, and introduce ideas and changes most Americans will not get. This election is simply about defeating the dangerous, corrupt, and treasonous occupant in the White House.
Focus on a return to sanity and normality, and American values, not on massive social change.
Senator Warren, I now fear you are not politically savvy enough to win this campaign.
2
I had no idea Warren and Sanders were pushing a plan that cost that much. There is is no way they will win the general by embracing a plan that costs that much. This kind of thing isn’t possible unless the entire nation—both parties—are supporting it. I’ll be voting for Mayor Pete or Biden now and will pray one of them wins. It is sheer political incompetence to run on a plan that will cost $35 trillion or $52 trillion dollars. Trump will destroy any candidate running on spending that much.
1
What 50 and 60 year-old doctors are retiring? Not the doctors I go to.
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."
1
Unless we get rid of all the people who are in the medical professions for the wrong reasons, we won't be able to implement a national health care system, whether we call it medicare for all or something else. Too many people become surgeons and anesthesiologists for the money, not because they have a calling. People go to Yale medical school to become rich. Not to help. If we don't implement a deep revolution in the way people live and work our economy will never sustain any type of national healthcare system. Our population is sick, mentally and physically, grossly sick. Look around you anywhere you are, at the behaviors and the bodies. Americans are sick in their bodies and minds! This is going to take down any National Health Care system that will be created. The transfer of wealth to the 1% and the take over of our governments by corporations, through that form of legalized corruption called lobbying has put, since the 80s, an unmanageable stress on our population that is just sinking and will draw more and more on any health care system that will become unable to cope, very soon. Instead of just focusing on issues such as health care for all we are losing sight of the fact that we should work at creating a more humane society than what we have become in the past 40 since that big mistake called Reagan. Our country and stock market is doing great. This population is not.
3
@Philippe Orlando. Newsflash for you, if you paid all doctors in America $0, you would only save 10% of total health care costs. The biggest labor cost of American health care are the nursing staff, which are heavily unionized. Good luck cutting their salaries to make any dent.
This doctor bashing is so misplaced and harmful to our society.
The *point* is not to save money. It is 1. to provide basic health care to all Americans 2. as expeditiously as possible.
We have accepted progressive taxation for a century. Progressively restructuring taxes to balance the books is no vice.
You would have to be very naive to suppose that a tax regime like this would not hit the middle class hard. With taxes on billionaires and stock transactions, the stock market would plummet, cutting everyone's IRA and 401K in half. Higher taxes on corporations? They will react with price increases on everything to sell to everyone. Fees on banks? They will cut the already miniscule interest rates they pay, and raise the fees on their accounts. Everyone would pay more for everything, and get less.
5
A doctor commentator wrote of his fears about his income being reduced substantially under Medicare For All. A salary of $120K was mentioned. I'm not sure where that number came from, but in California, cops, PG&E linemen, plumbers, big diesel mechanics, etc.. can earn that much per year - sometimes with over-time.
I expect that doctors will have to get paid mostly what they are getting paid now with appropriate annual increases. My niece - in residency in neurology - tells me that she will make about $350K per year when she finishes her training. Ok. Doctors' salaries are going to have to be adequate.
But if we just start getting fair pricing on meds and getting medical insurance co's profits out of the system, that would save 100s of billions per year.
Some years back I got an MRI on my knee. Private insurance cost was about $1200. On Medicare, that cost is about $250. Exorbitant fees for radiology studies is also an expense driver. We need fair pricing for everything and we need to reduce admin overhead - 30% private vs. 6% for Medicare.
All doctors should practice in groups like the Mayo Clinic, Cleveland Clinic or University Medical Center clinics & hospitals. Docs should get paid a salary. Their income should not depend on doing a specific procedure or not doing a procedure. Med science should direct all treatment decisions without any direct economic benefit from performing or not performing treatment. That will also result in efficiency.
6
My wife and I turned 65 this year and became Medicare eligible. We both worked over four decades and paid into the system to help support our use of it as seniors. Medicare for all means everyone who never paid in will be eligible. Not entirely fair or economically reasonable. Warren also proposes taxing stock value appreciation versus income from the sale of investments. Double whammy for those like us who do not have employer pensions and live off investments. Do we get a deduction when our stock values fall? Our children worked and we paid for their college education. Is it fair to those who did so to subsidize forgiving student loans for those who did not? While broadening health care and educational opportunities is laudable, free everything for everybody is not a path to broader prosperity; it is a formula for abuse, overuse and eventual economic failure. A moderate approach such as buying into medicare coverage at a younger age, but paying higher rates makes more sense. This would be similar to Social Security. Those who file early get a lower monthly payment than those who wait.
13
Our current Tower of Babel is still unsustainable. Count me among the physicians ready to make the transition although my confidence that our government can run health care efficiently without it becoming a Kafkaesque bureaucratic nightmare Is not very high. The assumptions of improved government efficiency including IRS are so unrealistic. Despite those reservations our current "system" is corrupt and wasteful with priorities misdirected, all about profit not patient care. Agree with others commenting on the role of personal responsibility Andy cultural change to emphasize and reward healthy living habits and the social determinants of health, i.e. Education, poverty and ability to earn a living wage
4
Should there be government healthcare; How many C.E.O.'s and top executive positions in the private health sector would lose their jobs, perks and other benefits? No wonder they are fighting universal heath care and making people feel afraid of it, it's the American way. And shouldn't Americans have the same access to health care that their politicians have. Someone should ask Bernie Sanders as he seems to never mention it.
Revising how health care costs are paid is rearranging the deck chairs on the Titanic. You can decrease some costs by negotiating pharmaceutical costs, maybe reigning in some very expensive procedures.
But what's needed to really reduce costs is healthier lifestyles, decrease in substance abuse, and more rational and compassionate end of life care. Research expenditures on how to get people to "live healthy ", how to decrease substance abuse, are minimal compared to pharmaceutical-directed research.
Education of patients and families as to what is reasonable to expect from medical care is also a msjor unaddressed factor.
7
"Other health care experts call the ideas unrealistic, given the revenue that American doctors, hospitals and drug companies have become accustomed to earning."
Back in 2013, the NY Times published an article titled "How to Charge $546 for 6 Liters of Salt Water".
At the time, the total cost per liter was around $0.44.
Just because they are "accustomed to earning" outrageous markups doesn't mean it is sustainable, because it isn't. The current system is built on a series of cartels with incentives to increase costs and prices.
That can change, especially if the system is approaching a tipping point of collapse. Many other labor intensive sectors of the economy (automotive, financial, etc) have reduced costs by 90% or more, while basic health care costs have risen unchecked.
Achieving "Medicare for All" in a single step is unrealistic, but many of the ideas could put us on a path to a health care system comparable to other developed countries that typically spend half as much for universal care.
4
@Look Ahead - Yes we could cut costs dramatically, but it would involve very substantial cuts in salaries and a large number of layoffs. Nearly everything we spend is someone's salary.
"The federal government now thinks health spending will increase by 5.5 percent a year; the Warren campaign assumes 3.9 percent growth under Medicare for all" ...
How does anyone think that a 5.5% compounded inflation rate is sustainable? How will we pay for healthcare WITHOUT democratic single payer negotiating power?
6
I'm a physician who just received a bill for almost $700 for a 10 minute non-invasive radiologic study I underwent. The study probably took the radiologist 5 minutes to read, and it was warranted. This is after my insurance paid.
As far as medicare for all, let's do it. I saw something about the NYT asking physicians to respond to being paid less-- I suspect it'll affect the high income, surgical specialties more than mine. Insofar as I'll get paid less, I'm counting on another of Warren's plans, her student debt plan, to help ease the $300K+ debt I've accrued (almost a third of that is interest) during my decade-long quest to become a physician to a vulnerable population.
14
The money is already out there. Just has to be redirected. instead of giving it to a private insurance company that does nothing, and takes 20% right off the top for their trouble, people will give it to a Medicare Fund. That doesn't have to make a profit, or deny care. Hopefully it will be streamlined and run well. It will certainly be so much easier for most Americans.
5
Somehow there is less scrutiny of where the money will come from for non-public services than for public services. There will always be health insurance. The issue is whether health insurers should profit from risk. The insured should. Should someone dissatisfied with the single payor package of benefits offered by gov have access to plans tailored to their preferences (and ultimately their risk profile)? That could be like the already existing wraparounds. But as two tiered systems have shown, the incentive to provide equitable quailty of care is poor.
But these are all cost shifting issues. Why are costs so high? Looking at rich countries (and except for Norway not the oil rich), health care services cost less. Looking at health statistics these countries are healthier: There is another health insurance product the politicians say less about. That is malpractice insurance, a major driver health care costs. Assuring quality of care is at least as important as access to care. The “health industrial complex” must change structurally. That requires strategic thinking politicians are too busy winning votes to think about. But Mr. Warren Buffet with a malpractice insurance company on the one hand and a “health care innovation project” on the other must be considering this, esp being in a position to manage if not lead. the much needed structural change.
1
Even if the plan that Warren is proposing is not feasible in its entirety and not likely to get passed by Congress, from every moral and practical point of view it points in the right direction. So it is at least a start.
The United States is the only major industrial economy in the world that does not have a national health plan. On top of that the costs of medical and hospital care and prescriptions are higher than almost any other country in the world.
We also have a higher percentage of uninsured than many industrialized modern countries. That is a shame and a disgrace.
Trump if anyone should understand this. He talks about "The Art of the Deal." But if you want to make a deal, especially one that breaks through existing barriers, it is good bargaining to start with the best outcome you think is feasible, and negotiate with that as a starting point.
That is what Elizabeth Warren and Sanders have one, and they deserve credit for their courage and wisdom.
(Spoken as one who already has Medicare, but who is concerned for the welfare of others.)
8
And... right into the arms of the GOP. Moving as far to the left as Trump is to the right is not a winning strategy.
8
@MLinus But Trump did win by doing just that. So literally by definition, it IS a winning strategy. Not guaranteed, but clearly feasible.
1
Have I misunderstood this whole thing? I don't see employee insurance contributions anywhere in this budget. Is the plan to actually offer *free* Medicare for All? Will somebody please enlighten me?
2
@Michael Freeston Yeah buddy, that’s the whole idea. Use a tax system to pay for healthcare instead of individual insurance contributions, so the system can be tuned such that high earners and companies pay more and low earners pay less, instead of at-risk people paying the most or being priced out.
Yes— “Income tax collections would increase, since workers would no longer pay part of their salaries for insurance premiums, which are not taxed now. ($1.4 trillion).” Instead of paying insurance premiums, income tax increases. TBD by how much, based on your tax bracket.
I don't understand the naysayers. Medicare for all makes sense at a very intuitive level.
1) Healthcare in the US costs twice as much as any other country and the results are way inferior. Implementing a comprehensive system would be an improvement. It has proven itself elsewhere.
2) Just like public education, public heath care is a right. Why shouldn't every person in this society have access to proper health care? Do you really want to live in a world where some people have access to medicine and others don't? The same goes for housing and childcare. We are all diminished when some do without the basics.
3) What is the rhyme or reason of the tax code to begin with? All wealth is the product of human labor. Right now the distribution of that wealth is currently skewed in the direction of those that allot a portion of their gains to politicians that write laws that maintain an inequitable distribution. That is neither fair nor democratic. It is entirely reasonable to have those (the wealthy) that have benefited from this corruption pay more in taxes.
4) The pharmaceutical companies get away with murder. Does it make sense to put an end to that? Yes. Will they object? Yes. Should they be able to continue ripping off the public? No.
5) Does it make sense to hold society hostage to the insanely wasteful insurance firms? No.
The public is capable of grasping these basic concepts. That's what the vested interests are afraid of. Don't fall for their propaganda. Right is right.
8
Mr Obama sad that government take over of student loans would turn a profit for the treasury. Now, leading candidates want a $1 trillion plus write off. The cost and projections never work out. Medicare is projected to run out of money fairly soon and Washington won’t fix this. I simply have lost faith.
3
The Medicare for All reimbursement rates Warren is proposing, 110% of Medicare, are half what insurance companies reimburse, 241% on average in 2017. Healthcare workers are among the few professions left where young people can graduate from junior college, 4-year programs, or graduate school and earn a living wage. Hospitals that earn such rates now get poor marks for patient quality. Warren's proposals will end up hurting both the workers she wants to help and patients. A public option will preserve wages and our healthcare system.
8
Here in Canada we do have medicare for all, and it works well in a basic way. But the weakness of the system is that the ever-expanding costs are mostly funded from taxes, and there is always resistance to tax increases, which means that we are under-funded relative to the USA. This shows up in rationing and waiting, e.g., waiting months for an MRI or waiting for months or even years for a knee or hip replacement. There are major shortages of specialists, with wait times of months (e.g., dermatology and gastroenterology). People we know in the USA get much faster and better service, which they would be unwilling to exchange for the lowest-common-denominator system that we have.
Rather than copying our plan and regretting that decision, you would do better to learn from various European systems which are a blend of private and public insurance and which provide better service. Don't be rigid in your thinking - learn from others who do it better. There are some good examples in Europe.
47
@John D. -- Appreciate the nuance of your comments. There was an amazing article somewhere I read on the public-private partnership of the health care in Germany. However, development of that partnership required time and cooperation of all parties involved.
However, the USA has a culture of winner-take-all and worship of the powerful and tends to malign those who call for cooperative enterprises as "communists." Not only are the powerful lords of the American Health Care Cartel powerful, they are increasing their power, and in fear of their eventual defeat by the forces of the citizenry, in an act of self-fulfilling prophecy, have for 20 years jacked up prices far beyond what is necessary for reasonable profit, and so have driven citizens insane with the anger the Cartel claims not to understantd..
I can't ever remember seeing in the American press that Blue Cross or Cigna or some other behemoth went out of business or is under financial pressure. These companies have jacked up prices for the last 20 years (note the latest on insulin) simply to buttress profits.
In such cases, it is the responsibility of government to institute a new paradigm under which the government will control the economic model and reduce costs to citizens.
3
@Kip Leitner Thanks for your comment. There is a good article on the German system right here in the New York Times: https://www.nytimes.com/2019/02/20/opinion/health-care-germany.html
Married to an American and with a daughter engaged to an American, I hear a lot about the great service that people close to us are getting in the USA. We also used to get all the Medicare and Blue Cross statements for my mother-in-law in Florida and were completely blown away by the amazing range and speed of the services which she got, and which seniors here either don't get or which are subject to long delays (especially if you are a senior citizen). We couldn't believe how quickly she got services and how thorough they were, particularly including the services of specialists that would take a long time here. For example, she was able to get Moh surgery within 2 weeks, whereas here in Ottawa the average wait time for this is 18 weeks.
1
Her polling is going to go down with this. She may expect that.
It’ll be instructive to see what her response is.
3
Give me some time and a staff and I too can come up with a plan for just about anything.
I can also come up with a plan to pay for it. One aspect would be that newspapers pay a tax on articles and commentors pay a tax on comments.
Plans are easy.
What is hard is actually undertaking the plan and succeeding. I cannot see how Ms. Warren thinks that she will be able to actually accomplish all this, i.e. convince those who have to be convinced.
It has been my experience that those who come up with such detailed plans based on wishful thinking are too rigid to pivot when faced with reality.
11
Land value (not value of improvements aka buildings) apportioned among the states, can pay for anything we want with no dead weight loss because supply of land is inelastic.
BTW, land value is even more maldistributed than income!
But why not also gradually increasing taxes on cigarettes and ammunition and miles driven and obesity.
4
All I can say is this. I worked really hard in college and in medical school so that I could get into a competitive residency. I spent 120’hrs a week for 5 years. Now I work 80 hrs a week see 500 patients a month and do about 50 operations. I’m in call 15 days a month. And let’s be honest I have my phone all the time because even if I’m not on call I still get calls. I deal with Medicare every day telling me what I can and can’t do for my patient after I spent all that time learning what was best for my patient. Instead some uneducated bearcat tells me what to do. If Medicare for all passes and they cut what that pay me be the 3/4ths I have heat then I’m throwing my phone in the ocean and good luck finding a doctor that answers the phone. I’m not doing it for less. And I promise you I’m not alone.
43
@Donald
You point out excellent reasons why we need three times the number of physicians that we have today and why we should fully fund medical school costs for students. Then there will be enough docs to go around. There certainly are enough excellent applicants for med schools now. I doubt we'd have difficulty finding enough qualified med students who'd be willing to work for $120k per year. And with triple the number of physicians, you could have a reasonable 40 hour work week.
]
21
@Donald, not saying I discount what you are saying, but it doesn't mean the current system is working. Insurance companies don't always pay for what you think is right either.
3
Yeah I’m not sure you are gonna find as many people as you think to do what it takes to get into medical school and through residency for 120k a year. Not when statistically the people who get into medical school are the top students in the country and most could get into anything else they wanted to. We go to medical school become we love to the profession and love taking care of patients. But it’s really hard and stressful work. Patients die when we make wrong decisions. It keeps you up at night. We are willing to pay pro athletes millions but you want to pay the person who holds your life in his or her hands 120k. Interesting
35
All these complex plans are nothing but wastes of time at this point in the political process. Any plan will be incredibly altered moving through the processes of the House and Senate.
5
@David Gregory
Yes, but the point is to understand what the candidate will push for. That's critical to know now before we vote.
5
@David Gregory, surely you know that only Republicans are allowed to have vague policy proposals? She's not allowed to promise that Mexico will pay for it.
The proposal as is looks like a total non starter. One thing that she and others don't do is to define what they mean by the "middle class" that would be protected from the huge tax increases needed to finance her proposal. I suspect that her upper limit on what is considered middle class would exclude millions of urban residents who barely make enough to afford an existence above poverty level, and can't even think about such middle class basics as owning their own home.
Another problem area is the proposal to tax employers what they are already paying in health coverage benefits. Employers offer health benefits for a variety of reasons, largely to gain competitive advantage in being able to hire and retain quality employees by offering them a benefit that the employees don't have to pay tax on. Other employers, despite the current business climate elevating corporate greed above all, offer health benefits simply because it seems like the right thing to do. Under Warren's proposal employers who currently offer health benefits must continue to bear the cost without any of their current benefits. Meanwhile, the stingy employers would get off scot free, putting their competitors at a great disadvantage. That seems quite the opposite of a fair and just approach.
This isn't a plan; it's a wish list gussied up with some numbers that don't represent anything that could be enacted in the real world. It doesn't begin to cover how to finance the rest of her wish list.
15
@dennis
There's no reason to "suspect" who she's proposing pay more taxes. It's all in her document. She raises investment taxes on the top 1% of income earners and has a wealth tax on those with $50 million or more in wealth; this wealth tax gets larger on wealth over $1 billion. If you're below the top 1%, you don't pay an additional taxes.
1
@617to416
No, she said that the middle class wouldn't pay any more taxes, but doesn't define what she considers to be middle class. Sen. Sanders doesn't define middle class either, but at least is honest enough to say that middle class taxpayers would pay more.
3
@617to416 The middle class make financial transactions and have businesses. They put money into banks and use credit cards issued by banks. All those costs will go up. To say, “if you’re below the top 1%, you don’t pay... additional taxes” is simply absurd. Reread the piece, it’s all in her document.
Ms. Warren means well but may find that such attempts by liberals to help the needful will face too much resistance from wealthy taxpayers and profiteers , who may have the power to throttle the plan. The drug industry which makes a much higher profit from this country than from any other country will unload a torrent of funds for lobbying into the coffers of those Republicans who support them ("legal bribes" allowed by "Citizens United"). Similarly the Health Care Industry--hospitals and staff--will join. Expect a barrage of ads condemning "Socialist Medicine' sponsored by Socialist Democrats.
Regarding the wealth tax which Ms. Warren plans to raise to 6% from 3%---bear in mind that it has been tried in four or five European countries and failed. It depends on asset valuation and the wealthy tend to hide their assets or use expert accountants and lawyers to devalue them. The European states found that it was too expensive to try and collect this tax and that it yielded much less than expected.
One possible tax that might help would be a tax on dividends, if all corporations were required to pay a percentage of profits as dividends . (When Buffet said his secretary pays a higher tax rate than he does, he had in mind that most of his assets grow without paying taxes, as his Berkshire Hathaway gives no dividends.)
All in all, this is very tricky and will face strong and moneyed opposition, but is well intended. That medicare for the elderly passed is almost miraculous.
3
@shimr The initial estimate of worth for non-financial assets will be the insurance valuation. A hammer to make the valuations more realistic is to force the holder to sell the asset at appraised price to the government at the reuest from the government. Of course, holders can hide their assets. But the government can also offer third parties payments for finding hidden assets--perhaps 5-10% of asset value. Think of all the homeless and unemployed people who could be taught to chase after hidden assets in exchange for recoveries of 5-10 cents on the dollar.
1
@shimr
There’s no good reason to think a wealth tax couldn’t work here:
https://www.washingtonpost.com/outlook/wealth-taxes-often-failed-in-europe-they-wouldnt-here/2019/10/25/23a59cb0-f4ff-11e9-829d-87b12c2f85dd_story.html
After having NO insurance for several years, because it was flat out catastrophe insurance ($700/month for $10,000 deductible); we found that it was more cost effective to pay cash for medical services.
Now that we are covered my medicare and a secondary insurance ($500/month with $185 deductible for 2 people), we are happy campers. We actually go to the Doctor!
I think that if we took out more for medicare from payroll (1 percent increase, with employers paying the matching 1 percent, 2 percent total) we could really help support the medicare for all. Having a set point for services (like medicare has) stops this dysfunctional pricing in America; if you ask your Dr. how much a procedure will cost, most likely he/she will not know, it is how much they can get the patients insurance to pay! For example, I just had an electrocardiogram, the hospital charged $1,900. Medicare approved $531 (they paid 80% $425, and my secondary insurance paid the remaining $106). This is truly functioning insurance! Health care for all, or Medicare for all works!
The most annoying thing is that the very politicians who make decisions on this issue are on government insurance; healthcare for all, they have theirs, and the rest of us should get lost! Thank you, Sue
2
This is short sighted. Medicare presently pays only 80 percent. Medicare for all - who pays? Medicaid is free. And why is Medicare for all a topic for anyone under 65? You don't get it until you're 65. Is Medicare for all going to insure people under 65 when private insurance is eliminated? This sounds like Obamacare 2.0. Remember "you can keep your health plan"? That went well.
3
What happens if hospitals and doctors won't accept the governments lower medicare payments? Instead they suspend services and lock down the hospitals. Then what? Outside of veterans hospitals, most public ones are privately held and staffs aren't government employees. Ms. Warren makes no comment regarding this. She's planning on enough people hearing and believing in her something for nothing pablum and voting for her in response. Yet another wolf in sheep's clothing.
3
@Kurt Pickard
Well if we go to this system the only payments available will be the government's payments. Of course, we have this system in Canada and we still miraculously have hospitals and doctors here. Warren is betting on administrative costs dropping so much for doctors and hospitals that the Medicare rates will be more sufficient. But I suspect if we do go for single payer, there will be a lot of give and take in the negotiations. The government will have a lot of leverage to bring costs down, but if they bring them down too low and doctors and hospitals start disappearing they'll have to raise them.
1
@617to416 What will all of the closed hospitals and physicians do when they refuse to accept payment levels from the government? Can they live out the rest of their liives without funds?
This will be a negotiation. Rather than having helpless individuals with no medical expertise to bargain against, the hospitals and doctors will have an informed government negotiating against them. Hospitals and doctors will not have the option of saying they don't know their costs. And there might even be competition among the providers.
smart thinking, doctors will have no choice but to accept lower payments. That might work for the current crop but then who's going to want to become a doctor knowing that they're going to be paid peanuts
1
Lots of wishful thinking here (why doesn't she include the private insurance premiums that are now paid, and that would disappear?).
We would get one big HMO, with no alternative when it turns down necessary but expensive care. HMOs went out of favor when they had a reputation for doing that, but then people had alternatives---avoid the most abusive HMOs, shift to fee-for-service insurance.
@Jonathan Katz
She replaces employer-paid private premiums with her employer contribution to Medicare, so she essentially is just redirecting employer money from insurance companies to Medicare. The taxes on the wealthy replace the premiums and out-of-pocket costs now paid by employees or people who buy individual policies as well as fund insurance for people who are currently are uninsured.
And no, it doesn't produce HMOs. (That's something Kamala Harris's plan might do, however as she is proposing using the Medicare Advantage model for her public option.)
1
@Jonathan Katz, that's what the "death panels" are for. The government shouldn't be turning down necessary care just because it's expensive, but there would almost certainly be cases where say a new experimental drug could be tried where a government panel decides it won't pay.
Of course that also happens now with private insurance.
The wealth tax is a great idea but not constitutionally. So, where does thatleave Medicare for All?
The reality is that we have to stop spending billions in the last year of folks’ lives. We cannot afford that.
1
If doctors are against Medicare for All, why has the AMA (at last) decided to support it?
@Michael Freeston
The AMA hasn’t represented most physicians views for a long time now. That’s why their membership is 20% what is was just a decade ago. It’s been overtaken by the left, for exactly the reason to stoke the question you’re asking.
They are like a union, only arguing for lower wages and less autonomy for their constituents. So, like the opposite of a union.
6
@Michael Freeston
Lots of doctors are for it. Lots of doctors hate insurance companies even more than Medicare. And lots of doctors really do care about their patients' ability to afford and access care. While there are greedy doctors, most of them I think are actually pretty altruistic people. It's a very difficult job and not one that you'd stick with in most cases if you don't like helping people. It's a lot easier to make money in finance or law, I think, than in medicine.
Because most doctors don’t belong to the AMA. Because most of what they do is not in physicians best interest.
1
The media don't ask Republicans how they plan to pay for the crazily expensive budget busters they dream up, like new perpetual wars; extravagant tax cuts for the super rich; trips to the moon and to Mars, and Spaace Foorce! But they all become fretful bookkeepers when a Democrat proposes doing something "extreme far left" like attending to basic needs, such as giving us a health care system that isn't a total catastrophe.
Democrats should stop submitting complex schemes to move money around to pay for the basics. When the concern trolls wail that the cookie jar is empty, ignore them and forge ahead.
Elizabeth Warren for president.
15
@Mike Cost of a war in Iraq, $2 trillion. Cost of mission to Mars, $ 6 billion dollars. Cost of Medicare for All, priceless.
Strongly support the proposal and am adamantly opposed to it. Problem is that sabotage by the Right will sink the most perfect plan.
Remember “Death Panels?” How to pay for it is not the issue. How can truth overcome messaging based on lies?!?
When i read the part she would end private insurance I am for Medicare for all . The private Insurance’s are run and backed by our wealthy GOP politicians who with every plan they come up with will charge all Americans 5percent or higher . The private insurance companies are crooks who over price every thing and have gotten away with it for 70 years. Enough is enough make the rich like Trump pay yearly taxes and back taxes they cheated us on and there will be money for Medicare for all and affordable housing.
2
Many in these posts are commenting on what it took for Obama to get Obamacare passed. here is how it passed:
We do know what they did to get ACA passed; repeating hundreds of times the 3 biggest lies in American history (no challenge from the media on these easy to point out lies: 1) You can keep your benefits. The law itself had hundreds of pages on the fact that you must lose your coverage and enroll in govt defined benefits (Gold, Silver, Bronze plans...), 2) You will not lose your doctors. Millions lost their doctor because there was nothing in the law said this and health plans are always changing their network of doctors, 3) Every family will have their premiums reduced by $5000 per year. This was said after insurance companies went before Congress and testified that guarantee issue where everyone can get regardless of your health conditions and much richer benefits would result in 50%-200% rate increase. This proved to be woefully too low and rates have gone up about 200% since 2014.
@JLee
You’re right but you’re pointing fingers at the wrong people. When the insurance actuaries said that premiums would fall, it was with the irrational expectation that everyone would sign up. Of course it didn’t take much math acumen to realize that the young and healthy would take their chances, accept a tax penalty, and avoid paying outrageous premiums for health service they would most probably never use.
It was an ill conceived plan with no bipartisan support that was doomed to fail.
1
This country will never have Medicare for all -- and any increase in taxes on the rich -- unless both houses of Congress are controlled by a super majority of Democrats and the White House is occupied by a Democrat. Not only the Republicans sunk the Clinton health plan, the Blue Dog Democrats did as well. Presidential candidates should be discussing what they will do when they are in office if there isn't a Democratic Congressional majority, i.e., executive branch policy.
Perhaps I miscounted but I only netted $40 Trillion over the ten years compared to the $52 Trillion the article mentioned at the outset. Where's the other twelve trillion come from. Just curious. Did anyone else do the math or can anyone else help explain the discrepancy.
1
It doesn't really matter what her plan is, since there is no chance of it getting enacted in the Congress of the foreseeable future.
It would be great if, rather than putting forth theoretical pie in the sky ideas (as worthy as they may be), the Democratic presidential candidates would instead talk about, in real terms, how they would negotiate the current political climate. Let's get back to reality.
7
The Republicans do not want any health care plan of any kind. They have made that abundantly clear for decades. The problem with predicating this debate on health insurance and coverage alone is that it ignores the elephant in the room. Nothing will work as long as we have a for profit medical system. All roads that lead away from the for profit model, higher taxes on the wealthy, elimination of government welfare for the pharmaceutical, medical device and hospital industries, the Very existence of these industries as corporate entities and so on, all attack income inequality. And that the Republican Party will never tolerate. Meanwhile they spend hundreds of millions of dollars (peanuts) on propaganda through their house organs like Fox News and talk radio to persuade their victims to keep voting for them.
6
Bottom line is the current system is not working.
Healthcare companies, their executives, pharmaceutical companies and their executives are laughing all the way to the bank. They conned us into HMOs and PPOs 20 years ago with the fallacy that it would provide better care and lower costs, but it did the opposite.
Allow Americans to BUY into a government plan, regardless of their income or savings. Private insurance companies would have to compete with a national/federal plan, which means costs would go down and coverage would go up.
Whatever Warren is proposing would not pass AS IS, it would be a pared down version, but she is headed in the right direction. American for the people, for Main Street and not insurance and pharma companies and their executives.
She is swinging the pendulum. It is better than the status quo. She has the power to create real change.
We cannot go on this way.
6
@Gus government plans? Like Obama care?
People who want Medicare for All because of “cost savings” don’t seem to be advocating for just that. You could have one insurer who everyone pays if that is the goal. The real goal is to shift who pays the insurer though.
1
@Bk2 it’s bad enough and she wants to turn it over to the God help us, the government.
1
Ms. Warren has released a detailed plan on how her version of medicare for all will be theoretically paid for but once again there is no explanation as to how several of these line items that will require Congressional approval will be achieved.
Achievement does matter.
Is she clairvoyant and has predicted that we democrats will regain Senate majority and maintain the House majority in 2020? If we don't regain Senate majority this plan will go nowhere.
We should repair and build on Obamacare which has far more bipartisan consensus in comparison to a government mandated one size fits all system while focusing on day one to repair all the damage done to all of the federal agencies that Trump has corrupted.
Take progressive positive steps towards universal healthcare to get there, it's a funny thing about people, they don't like to be force fed even if it's for their own good.
4
@Winston Towne
What makes you think improvements to Obamacare have any more chance of getting bipartisan support? Right now the Republicans are challenging the Constitutionality of the ACA in the Courts with the hope of killing the entire plan. They may very well win in their Republican-stacked Supreme Court. The odd thing is if they do win in the Court, then single payer may become a more feasible solution than improvements to Obamacare.
As far as your last comment . . . I'm not sure about people in general, but a lot of Americans sure do like to cut off their noses to spite their faces. That much is true.
1
The article hints at it but what about the revenue flows now enjoyed by the actors in the health care system, how would they adapt to the major loss of revenue ? Of particular concern would be the safety net hospitals which are currently struggling to survive.
3
@Speculator There are some actors in the health care system that are suffering, but many more who are laughing all the way to the bank. Other developed countries get much more from the health cares systems at far lower cost.
Obviously to reduce all the bloat, some people will have to settle for less or leave the industry. They are in the same situation as the coal miners: the nation is not in a position to support them any longer.
Hopefully they will find other opportunities. That would be better than having the government bail them out.
What Elizabeth Warren is proposing is based on the plight of people who are unable to afford their health insurance premium and the extras tied to the premium. Wealthy are not affected now ,so they are the ones shouting the criticisms loudest. If you look at it seriously, people in the lower rungs of the ladder( of pay scale) are losing the most with the current setup. They are not reading NY times and not commenting on articles. They are working 2-3 jobs just to get by. And here we are discussing the disadvantages of M4A which is expected to brings cost down(well,for everyone) but will REALLY help those who are truly suffering. All the strategies, which will help with covering everyone ,outlined by Warren make complete sense if you read them thoroughly. This topic on M4A has been commented by readers many times( including by me)and leads to the same conclusion. Everyone will be covered. No premiums,copays etc. Cost will come from taxes which will be less than what each of us pays now in premiums . People are being crushed under high deductibles and often forego important services. The real cost of care hits one on the face when one has to go ER or get admitted. We may supercede all developed countries in many ways,but health care is not one of them. In fact ,US health outcomes are closer to Afghanistan than UK and Germany.
5
If Senator Warren is able to fund Medicare-For-All from the sources she has listed where would she go to find money for her other proposals? Will she be going back to some of these same revenue sources to cover free college tuition, day care and student debt forgiveness? How about money for infrastructure?
8
@Horace Thank Elizabeth Warren for coming up with solution and putting a price tag on it. No other candidate has had the guts to do it. MFA is the best for all Americans.
5
@Horace is right. Warren seems to be double- or triple- counting many of the same revenue increases to fund a variety of new or enhanced expenditure programs.
1
@Horace. She is smart so she will deal with it when the time comes. Healthcare is a right and not a privilege.Childcare,tuition free college and other proposals are important too. But if you are not healthy and are broke because of high healthcare costs,nothing else matters that much. Tuition free college may sound great but if you are unhealthy which one takes precedence?
I support her plan 110% this country has to try and while it may stumble in the beginning I am sure it will find its way as other countries have. However, first thing Monday morning I will call my broker to sell all my health insurance company shares.
5
@D. Arnold
The insurance complex has been up 20% in the last month. May be a good time to sell based on that, but not on the silliness of even a sliver of her proposals coming to fruition.
1
And when it doesn't work?? What then?
1
It does not work now. Do you ask the s ask the same question? No. So be honest with yourself. It is not that hard.
@Steven
And what we have now doesn't work, so what then do you propose?
Then we can go back to our current mess.
Against Medicare for All - non-college educated white males.
For - Moms.
2
Create article, though I am not sure I agree with it.
I want evolution by choice, not collectivization.
7
@HelgaGiselaMeisterzock Do you have any idea of what collectivization is? State ownership of the means of production has nothing to do with how we pay for medical services.
2
Dear Prudence:
If evolution worked by consent, it wouldn’t be evolution.
Please deposit .25 for next play.
Soncerly, Charles Erasmus Darwin
These kinds of stories should include how much it costs to purchase and use the system we have now. Because I don’t love the insurance we get through work, and it’s expensive. And the charges after I had kids and their few ER visits? Not very reasonable.
6
The public option may be easier to pass, but I'm not sure it does much to improve our health care system. Essentially it just adds one more plan to the plans on the exchanges. You still need to buy the plan (pay premiums) and it likely still has a deductible and requires copays and coinsurance, so there are still costs to the insured. Maybe it's cheaper than the private plans on the exchanges—and maybe it fills in when private plans drop out of a market—but basically it's just one more option similar to the private options that already exist.
People talk about having "choice"—but what really are you choosing? Everyone wants the same thing in an insurance plan—the widest range of covered services, the fewest restrictions on providers and services, and the lowest cost. It's not like you're choosing between the blue leather and the pink silk. It's merely a cost and coverage decision. A single payer plan like that proposed by Warren costs nothing (no premiums, no deductibles, no copays and no coinsurance) and covers everything. Why would you choose anything else? Do you prefer to pay more for less?
5
@617to416
Single payer does not "cost nothing". Medical care has to be paid for somehow. The question is how.
4
@617to416 It would be good if a government plan offered insurance to people with pre-existing conditions, and people over 50, at a reasonable price.
1
@Jonathan Katz
It costs nothing to get the insurance or use it. There are no premiums to be paid and the plan covers all services at 100% with no deductibles, copays, or coinsurance.
Of course the plan is funded by taxes, so the taxpayers do pay for it. But every American, whether he or she pays taxes or not and regardless of how much he or she pays in taxes, would get the insurance at no cost.
2
Warren is making it easier for trump to get another four years.
22
Don’t do this to us, Elizabeth! All candidates make big promises about what they “will” do if elected, but they should be more realistic - and up front - about what can be accomplished. Even if we managed to get a majority of Democratic senators, they would all squabble for years about a major overhaul of health care.
Of course it alarms us all to discard our existing health care! (We happen to love our current medicare supplement.) If Bernie & Elizabeth, bless their hearts, keep pushing Medicare For All they will lose the election. Trump & Putin’s facebook/internet machine will have exactly the candidates they want to beat - “socialists who will raise taxes and take away your health care plan and you wont be able to see your old family doctor any more...”. I can hear it now.
We think Elizabeth & Pete would make a smart pair, but the party has to convince her to postpone Medicare for All and instead work to improve existing ACA. Trump fears facing a moderate candidate who could win votes from both parties. Elizabeth’s health plan is going to get Trump re-elected. We are sick at heart - we believe this tyrant is highly likely to win again. Please, Elizabeth Warren, be reasonable, listen to your voters!
12
@Patricia B
Overall you would save money on health care, just as everybody does in Europe.
Here is a list of countries that have universal healthcare. Many of them are by no means wealthy. The list includes Spain, Greece, Slovenia, and South Korea.
To say that the richest country in the world cannot afford universal healthcare is ludicrous.
Australia
Austria
Bahrain
Belgium
Brunei
Canada
Cyprus
Denmark
Finland
France
Germany
Greece
Hong Kong
Iceland
Ireland
Israel
Kuwait
Luxembourg
Netherlands
New Zealand
Norway
Portugal
Singapore
Slovenia
South Korea
Spain
Sweden
Switzerland
United Arab Emirates
United Kingdom
20
@Al Bennett
However, unlike Warren and Sanders plans, lot of them have a role for private insurance as well.
12
They all eat better, exercise more and have gun control. They also aren’t as drug addled as our society. They also don’t pay the full freight for pharmaceutical drugs.
2
@Al Bennett
We have universal health care. We don't have universal health insurance.
She might be a better analyst than the analysts.
5
Why not just go to the Feds Repo discount window and "borrow" 70 billion over night the way JP Morgan does to cover the gaps.
Das Bank is a drama about subterranean banking in cold waters.
Thanks Liz but enough with the taxes. Plus, I don't want or anyone else dictating the plan I should be on. This is still the US, not some socialist banana republic.
15
The banana republics don’t provide universal healthcare. We are one of the very few advanced economies that does not.
2
American Medicine is expensive by a factor of five compared to equivalent care in much of the world. Start there. One prescription medication I have required has gone from $85 month to $1300 month since 2002. Start there. Americans generally are ignorant about proactively sustaining their own health through diet and exercise. Start there. Don't start by stealing money from successful people who earned it legally. Theft. Call it what it would be.
7
The selfish person in me wants this adopted. Why? My wife is a physician who has a significant Medicaid population in her primary care practice. If all her patients were reimbursed at even current Medicare rates, her already good income would skyrocket even beyond pre-ACA levels, and we’d be able to fire our expensive billing service. We could probably retire in just a few years. Meanwhile, the hospitals, who have been making out like bandits under ACA, would be on a level playing field with us again.
But the pragmatist in me knows it’s a nonstarter. First and foremost, it’ll never get through DC aim a unworkable form. And if it did, the two million lost jobs are a pipe dream. Hospitals will close by the hundreds. Those that remain open will slash staffs. My son and daughter in law would both be unemployed. Corporations will pass on the taxes to customers, resulting in inflation. And people — especially the rich — will always find ways to game the system. The revenues will not be enough as people overuse the system, and the solution will include middle class tax hikes, a VAT, reimbursement cuts, and benefit cuts.
Perhaps worst of all, this proposal provides a compelling reason for many people to vote for the orange guy. What a useless distraction.
21
@David I thought the US had a shortage of health care workers, enough that we import doctors from other countries. Also, some rural areas have little health care, and doctors and nurses could move there.
3
We do have a medical worker shortage, albeit not where I live. The impacts will be on the edges or direct care. My son works for a health insurer. That job is gone. My daughter in law will find another gig but the hospital won’t be able to “afford” her ancillary services once reimbursements are cut.
1
@Frances Grimble we have both too few and a poor distribution of doctors, nurses, and other healthcare specialists. But this plan will worsen not alleviate those issues.
1
George McGovern in 1972 is Elizabeth Warren in 2020.
She will win Massachusetts.
Lose the the other 49
And, I voted McGovern, Carter, Mondale, Clinton, Gore, Obama, Clinton.
18
Here is a sentence of wisdom:
History does not repeat itself deterministically.
1
@Cosby
Spot on. My wife is as solid a democrat as they come, and even she couldn’t support warren.
Democrats know this deep down. They’ll never broker her out of convention.
I am not a numbers whiz, accountant math genius or such but one thing I know is instead of looking for places to get the money why don’t we make health care cheaper duh,,,? Doctors and related industries make obscene amounts of money,,, they are just looking around for ways to shake us down for more money,,,time to fight back.
5
@Oscar drs. Make obscene amounts of money? Ever check and see how much they are reimbursed? You probably didn’t go to 4 years of medical school, 4 years undergrad and then complete a residency program. Agonize over the health of your “customers” deal with late night phone calls meet Medicare requirements and deal with insurance companies. Maybe they should all quit and get a job like yours.
2
I thought illegal immigrants were already paying taxes. This is what has always been said of them, they're "paying taxes and contributing." I guess that isn't the case if making them citizens will suddenly result in a boon for the Treasury Department.
7
@Grunt
Undocumented immigrants pay gasoline Taxes and FICA and SSA (though they never get any benefits from their paycheck deductions for SSA) and DMV and Property Taxes (their rent pays for landlords property taxes) and Utility Taxes and Sales Taxes and State Taxes and County and City and Local Taxes. How many of them paying FICA deductions ever apply for a Tax Return?
1
@Blank
How much FICA comes out of $250 a week?
While each child costs $10,000 - $15,000 per year to educate. Not to mention free breakfast and lunch, and all medical requirements.
@Blank
How much FICA comes out of $250 a week?
As the comments indicate, there is a sharp divide and confusion as to how her plans would affect any given individual's taxes.
1
America is already spending about TWICE, PER CAPITA, what Canada spends on healthcare. That means every dollar spent on healthcare by either public or private groups and/or individuals, divided by the total population. But Canada is covering everyone, while at least 20% of Americans have no insurance or are woefully under-insured. Even Switzerland spends less, per capita, than the USA. In fact, Americans spend more for healthcare than any other OECD nation.
https://data.oecd.org/healthres/health-spending.htm
America is already spending the money. She just has to spend it more wisely.
10
For this socially liberal - fiscally conservative but otherwise disgusted with politics voter, I say to Elizabeth Warren and any other candidates who support MFA, no, no, never. Warren's plan is the most health care proposal I've seen. I will, however, vote for anyone as long as he or she isn't Donald J. Trump. Another four years of la Famille Trump would be even more damaging to the economy and country. The idea that the US Government can and would outlaw an entire sector of the free market is patently offensive. The UK's NHS and private health insurance co-exist side by side quite happily, and to think we can't do the same is ridiculous. More importantly, throwing in the towel on The Affordable Care Act simply because it wasn't 100% perfect on the first attempt would be to hand Republicans a victory they haven't ear and a defeat to the concept which it doesn't deserve. The ACA represents a much more creative and subtle solution to the problem of 9% uninsured than Warren's blunt force trauma solution. Tweaked in the right ways, the ACA is our best bet in the short run for affordably insuring all Americans. And to Don Berwick, who said he "thinks" Warren's plan is achievable and to anyone who disagrees, "show me yours." No, Mr. Berwick, it's not up to us to show you ours. It's up to Ms. Warren to present a credible plan or lose the voter without one. My first suggestion is that comments like this don't help her campaign.
12
If you check the CIA fact book you will see that with all the key values of health care: infant mortality, maternal mortality, life expectancy, the US is behind other industrialized countries.
At the same time health care costs in this country is among the highest in the world.
Obviously other countries get better healthcare for less money. Why is it not possible here?
11
@MrMortensen
False
The high rate of infant mortality is not because the health system we have is poor.
There are reasons that have nothing to do with the health care system we have.
It could be because there are individual d who could take advantage of our health care but don't.
Maybe they are drug addicts for example.
Yes we spend more than they do.
I recently moved to Israel.
I don't know how you would classify the system they have.
I know they spend less.
I also know why.
The doctor can only see you for 15 minutes.
That's not enough time to do a examination.
I am sure a lot of people are mis diagnosed.
So yes they spend less but they get less for it.
2
@lucky, not false at all. We have good health-care options, but poor access. People don't take advantage of what we have because they can't afford it. If you're going to talk about how good the "system" is then accessibility is definitely a factor, as it is a factor in our health outcomes.
1
@MrMortensen
Because we have large underclasses of people who neglect and abuse their bodies.
The math is simple. Every other country that has single insurer health care pays half what we do.
Any result here that does not result in us paying half indicates someone here is cooking the books. It is just that simple. Our problem is dishonesty and greed, nothing else.
8
I've read the details of what Obama and Nancy Pelosi had to do to get the ACA passed. It was a grueling thing that took months and lots of compromise. Therefore, realistically, in the USA a progressive who espouses Medicare for All probably can not be elected. And if by some miracle she did get elected, she would need a left leaning majority in both houses of Congress. So, I think the chances in the near future are Zero. However, I do think that Medicare for All is something that will gradually evolve as people get used to it and experience it providing we have a democratically controlled Congress long enough to safeguard the ACA with a public option. Sorry, I gave up on my youthful idealistic fairy tales after JFK was assassinated and I watched the Watergate Hearings.
8
@Katherine We do know what they did to get ACA passed; repeating hundreds of times the 3 biggest lies in American history (no challenge from the media on these easy to point out lies: 1) You can keep your benefits. The law itself had hundreds of pages on the fact that you must lose your coverage and enroll in govt defined benefits (Gold, Silver, Bronze plans...), 2) You will not lose your doctors. Millions lost their doctor because there was nothing in the law said this and health plans are always changing their network of doctors, 3) Every family will have their premiums reduced by $5000 per year. This was said after insurance companies went before Congress and testified that guarantee issue where everyone can get regardless of your health conditions and much richer benefits would result in 50%-200% rate increase. This proved to be woefully too low and rates have gone up about 200% since 2014.
Medicare was designed for the elderly and disabled. Not for young people of child bearing age. Has anyone considered the grave hazards of centralizing all women’s reproductive healthcare in the hands of the federal government, where an ultraconservative administration could cause widespread havoc?
Just ask the women of Missouri how much they appreciate having their menstrual cycles monitored by the Missouri State Department of Health as part of its abortion ban enforcement. No joke. Imagine what these misogynistic extremists could do if they got their hands on all women’s healthcare.
I’m opposed to Medicare for All for lots of reasons, one of which is the safety of keeping my own medical care to myself. A decentralized system has certain inefficiencies, but just as with computer security, there is also safety in that, too. That safety is a cost I’m willing to pay for.
10
@DCH
Healthcare in America costs $10,000 a year plus. Lucky for you and I that we have that allowance for our healthcare. For 10%~15% of Americans it just isn’t possible for them to pay that amount. Do we allow them to go without?
2
I am worried that over time our health care system will resemble our woeful K-12 system.
Very few communities have globally competitive public schools despite all the great intentions. Our country is one of the worst educated of the Western World.
I also don’t want health care under the control of any particular political party. Can you imagine what happens if all health care is under the control of Trump and McConnel? Why take that risk?
National health care in the USA is fraught with challenges that come with our society.
Why not change the laws to allow states or groups of states to implement a more state centered health care system. That way we can see what works or doesn’t work.
6
Regardless of the math, the proposal reeks of "I know what's best for you." While that may be true it is not a message whose style is well-received. A better approach would be "The country us us and we have a healthcare cost problem." A transition through a public option would give people expanded choice, allow for a naturalistic experiment and " let the market decide. "
7
@Frank This is a reflection of your ego issues, not a policy analysis. Why in the world would you think the market will decide anything? I hope you can find a way to get your emotions out of this and learn the facts about health care. Use critical thinking and facts first, emotionality later.
6
@Jill Thanks for the psychoanalysis. Markets are composed of people who are typically thought to act in self-interested ways when it comes to economics. If they can get equal or better health insurance for less money, they may move to Medicare. "Build a better mousetrap..."
1
Certainty. Peace of Mind.
Yes, this is a major step to provide everyone with access to quality healthcare when needed and necessary.
Goodbye to the current confusing and costly heath insurance programs. No more premiums. No more deductibles. No more out-of-pocket expenses.
Hello to a safe and sane healthcare for all.
9
@Dennis Wonder what the definition of Quality Health Care will be? Answer the government.
I like it. Basically, Medicare is already available and you already have been paying into it, through your employer and we're all just waiting until we're 65. In the interim, our employers pay for our health plans, so basically the employer just pays that same amount they've been paying the health care companies as a kind of tax per employee to the Govt, which funds Medicare, along with a few other sources of taxes they have to pull from. Does this mean companies like Aetna and Humana, Wellpoint...and on, do these companies go out of business or essentially just scale down somehow?
4
Our health care costs should be in proportion to what Germany's are. I don't know the the arithmetic behind Warren's talking trillions, but if the end result unreasonably exceeds Germany's ratio, down she goes.
2
Germans are also healthier people than Americans with our obesity, bad food and lack of physical exercise.
German medicine, like that of the rest of the world, is also subsidized indirectly by the USA.
We have 25-30 million Americans without health insurance. Insuring them would cost $250 - $300 billion. Why not just focus on them?
1
You do understand that their are huge population differences?
All this argumentative piffle ignores the fact that there is far more money than necessary in the hands of the very rich. Warren, and Sanders, and any other reasonable persons, hope to bring these resources back into the economy to help Americans, to pay people fairly for their labor, to afford them basic benefits that they deserve, and to be the nation we all heard we were destined to be. I don't see the problem.
12
I've worked as a scientist in Switzerland, Canada, Brazil, and the US. I'm an US born citizen. I'm a social guy and like discussing issues like health care and have known medical providers all over the world. Typically the conversation would center and wonder at how evil and expensive the US system is and the vast superiority of their health care system/country. Usually by the end of the evening they would reveal that they would like to immigrate to the states for better jobs and pay.
11
Therefore we have the best health care system we can have? Health care doesn't matter to elite professionals? Better pay and jobs depends on overpaying for health care with relatively poor outcomes and leaving 35 million people without health care? Is that your point?
What are you trying to say?
5
@bruce Those people don't have first hand knowledge of living the American health care system. So, they'll MUCH MUCH MUCH better jobs and pay to be shielded from it.
3
@bruce
Oh really?? Not a single one of my European relatives wants to emigrate. They are happy living in the ancestral community -- 750 years old -- and where grandpa, unfortunately of Hebraic origins, was the first MD 100 years ago. My father emigrated and could because he was Lutheran! Had he been Jewish, the US would not have admitted him. Another brother could only make it to France and his progeny with one, exception are pretty happy there in France. One family has spoken of emigrating to Portugal -- cheaper. The one member of my generation who crossed the pond is a relatively well off Trumpian libertarian living in assisted living (doesn't like the food) and on dialysis (Medicare!). Assisted living communities are often isolated -- and typically outside of some big cities in the USA, one must have a car.
Maybe I should look into some kind of repatriation or whatever it's called-- dual citizenship.. Would not mind being able to live in the EU.
Medicare For All can only work if we drop the cost of health services. In France, medical schools are very competitive, but if you get in you are awarded a free ride. The catch is that upon graduation you are required to “give back” by working in the public health care system for a number of years. Therefore no medical school debt requiring extremely high salaries to pay back. Also, France has an abundance of general practitioners where here in America we have a dearth, especially in rural areas. The reason being that most US medical students quickly move to specialized medicine in order to quickly pay back huge student loans. This is one of many underlying, systematic “causes” of the high cost of health care that will need to make addressed before a single payer health system will become economically viable
13
It is not a prerequisite but it is a good point. In the US there is a defacto substantial restriction on the supply of doctors over all. More medical schools and easier access financially would help increase the supply of doctors we need and bring pay requirements for doctors down.
I don't begrudge doctors good pay. I want the most qualified and dedicated people in that profession. But also, I want those who are not driven by money as the first criterion to be a doctor.
5
Well that wouldn’t work here. I believe doctors enjoy the salaries they’re making. It may not be worth it to go to medical school and make mediocre salary even if the schooling is free.
1
How about the cost of unemployment benefits of the many thousands employed currently in the private insurance and related services sectors?
4
@kaydayjay
Warren promised a second plan coming shortly to discuss the transition to her system, including managing the impact on insurance industry workers. I'm looking forward to reading it. She's laid out a feasible proposal for paying for single payer without raising middle class taxes. If she can propose a similarly feasible plan for transitioning to her single payer system, she'll have accomplished her goal of showing that single payer is more than a pipe dream. Yes, some of her proposals may need to be refined, but she's laid a good foundation to build on.
2
We don't have private 'market-based' police departments. We don't have private 'market-based' fire departments. Why do we have private, for-profit healthcare?
Let's try letting science drive healthcare rather than profits for a change.
Healthcare has positive externalities. Many of the proposed area of taxation have negative externalities. Taxes are an effective way to manage such externalities.
Let's let rational science and basic economic theory beat the rent-seekers and charlatans for once.
5
There are costs to developing and producing healthcare products. There are cost to hire highly trained doctors and nurses. There are cost to hiring administrators to run our healthcare system. Police departments and fire departments are highly inefficient and are not profitable, and citizens don’t get a return on their investment. New Orleans is a perfect example of a big government operating in losses while returning little to the public. When you remove profit as a motivation, what incentive is there to produce the best. When it isn’t you’re money, you have little incentive to see that it is used well or that it returns a value.
4
Besides being disingenuous in terms of both costs and revenues, the probability of job losses in the health care industry and the rest of the economy that would almost certainly result from Elizabeth Warren's plan would be enormously consequential, and risk lives in the process unless it were phased in very gradually. I speak as someone whose life was unquestionably saved by our existing healthcare system when I developed acute leukemia, as well as someone who worked as a physician “provider” in the system for 40 years, and also spent some time as an administrator, employer, and employee inpatient and outpatient settings. I am retired, so I have no ulterior motives other than that of a patient and a citizen.
Health care financing and delivery in the US absolutely need to change, but something as large and complex as our health care system will not respond well to sudden changes. You can be sure there will be unintended consequences if this is done by fiat. Elizabeth Warren and others may claim her plan affects only financing, and not the delivery of care, but make no mistake, they are intertwined. All Americans should be wary of quick and “easy” fixes when lives and the economy as a whole are at stake. A “public option” to the ACA or “Medicare for all who want it” should eventually attain the same goals as Warren’s plan in cost savings and universal coverage, but allow for mid-course corrections that will allow the system to adapt and minimize the risks.
21
Why Elizabeth would you be so detailed about your plan - do you not wish to win??
There is no patient responsibility built in the plan - in terms of copays, etc. countries with guaranteed health care (Finland, France, etc.). have copays that would bring in some responsibility. Why not your plan?
8
@rmaturi
Yes, a lot of the countries Sanders and Warren mention, do have a role for private insurance as well.
1
My only concern is that policy wonks may underestimate the impact of lowering payments to providers(e.g. nurses, physicians, all therapist and technician types, etc). There is enough money in the system to avoid touching salaries and wages (e.g. never-ending hospital system expansion budgets that have already put downward pressure on salaries/wages due to profit motive culture of health systems). Due to the aforementioned downward pressure, which is currently MBA culture driven, we have seen less incentive to pursue some healthcare professions, lowering quality (which is becoming very palpable, as students are avoiding questionable quality-of-life specialties that don't offer enticing salary reward). Trust me, we do not want healthcare to be the realm of the academically average. It actually maters. Although the media has driven an anti-healthcare provider narrative for some time, in the service of enlightening the public about how infallible the professions intrinsically are, those who go into these professions are truly warriors whom I am proud to consider colleagues. We need to keep the academic bar as high as possible.
8
@GM pardon, I meant to say how fallible the professions are
Another consideration is that total cost to the taxpayer will be much lower overall with Medicare. You can search the difference in administrative costs between traditional Medicare and insurance company Medicare Advantage plans.
Another plus with Medicare for all is leaving the hospital without having to haggle with insurance companies over billing issues.
3
This is excellent! I have asked candidates to do exactly this: simple to understand and analyze further.
I congratulate Liz Warren from taking the cue from Bernie and bringing it to this stage of clarity.
Whomever helped her with this crisp analysis deserve kudos. Bravi!
If Bernie and Liz run on the same ticket ( I don’t care about the order) and get AOC to be the Speaker of the House, we are in for a golden period in American History after hitting nadir.
Bless you Dear Bernie and Liz.
8
Introduce Medicare to those under 65 incrementally. At the beginning allow those 55 to 65 to opt into the new plan if they choose to pay additional taxes to participate. The American people now are paying on average $1,168 per month for health insurance premiums which is approx $14,000 per year for a family. Either the insured is paying the insurance co. directly out of pocket or their employer is paying the premium. And the $14,000 per year does not include deductibles oe co-payments. The $14,000 is for premiums alone
So any increase in taxes will nowhere near come close to $14,000 per year the average family is now paying, so joining the new Medicare for all Plan will result in a savings and a further benefit that they will no longer risk bankruptcy if they suffer a severe illness.
If the family has their health insurance paid by their employer, there should be a salary increase that will partially offset what your employer no longer will pay to the insurance company. Further the employer will be more competitive in the market place if the employer does not have the burden of carrying health insurance for their employees.
Another consideration is that total cost to the taxpayer will be much lower overall with Medicare. You can search the difference in administrative costs between traditional Medicare and insurance company Medicare Advantage plans.
Continued...
8
1. It is not how you insure that matters, it is what insurance is actually paying for that matters. Medicare for all (MFA) is political comfort food. Real reform should be about lowering the cost of insurance by dealing with inflated costs such as $150,000 per year cancer drugs.
2. Health care as a "right" is a great slogan but a bad policy since it means forever trying to define exactly what health care people have a right to and who will provide it. Cancer treatment for children -- well certainly. Lung transplants for chronic cigarette smokers -- this gets complicated. Also, if health care is a right and a company decides to sell an essential drug for $1,000,000 a year, does having a right to it mean the government has to pay, no questions asked? This can be an invitation to more predatory pricing. Health care is a responsibility of government and community. Calling it a right is not as simple as it sounds.
3. The Medicare For All math that matters is whether voters will support it. If it sounds good to 51% of Democrats, enough to give Warren the nomination, and no Republicans, the Democrats lose the national election and we get stuck with Trump (maybe) or another Republican with his/her own ideas.
4. Don't forget that MFA also has a drop dead quality to it -- Democrats/Federal government are going to force this on you whether you like it or not. This is a real problem in a national election and limits its appeal outside of Warren's hard core supporters.
8
There is plenty of money already in the system. It is all how it is distributed. If less was spent on overhead(profit) and aggressive bidding of health care products happened health care costs could be driven down. Health care manufacturers and insurers have grown fat and rich under our present system.
We also need to apply scientific methods to treatments to understand their efficacy and safety.
4
Changing the payer doesn’t reduce costs. It switches the burden. When Americans are ready to accept some restrictions to access, accept lower reimbursement rates to hospitals and doctors, accept not all drugs being covered, then we can talk about lowering over all costs
3
It gives the Government a negotiation power, that allows to bring cost down. That's how Medicare keeps expenses relatively low
6
@yulia Government regulation never reduces costs. It imposes costs with the intention of improving citizen wellbeing.
2
@yulia give me an example of where government has ever brought down the cost? I’ll give you 10 where they increase the cost.
1
What is unclear in all the noise but must be emphasized is 1) The absolute benefit (cost and moral) of having good healthcare coverage for everyone. The cost of avoiding diabetes or heart disease through proper counseling and nutrition is overwhelmingly preferable to allowing these diseases (and other 'social determinant' type diseases) to develop and then treat them as we do now and 2) Why changing WHO pays the healthcare bill should have any negative effect on HOW much the bill will be.
Medicare is a proven concept and is liked by providers and patients.
While any switch of this magnitude will be initially upsetting, terrible things were said about medicare, medicaid and the ACA in their time and all have proven to be beneficial.
The truth in the article is the effect that changes in reimbursement of this magnitude will have upon existing doctors and healthcare systems who are used to robbing Peter (private insurers) to pay Paul (medicaid and self-pays).
The system we have is a chimera that must be reformed. WE should start doing so .
13
How come it's this much?
Looking at oeso stats, my country, belgium, spends 5000$ per capita per year on healthcare (85% via public insurance, 15% out-of-pocket expenses like single bedroom in hospital and something we call 'brake money' to avoid abuse). And if you think we have waiting lists, neighbouring countries actually visit us to get quicker treatments. They credit it to doctor shortages.
X 327 M americans
X 10 years
I get to 16Trillion, not +50
Or does medicare include elderly care facilities and home nursing? This might become govt funded here and is estimated at another 2500$ per capita.
2
@Florian
The US currently spends about $11,000 per capita on medical care (about $3.5 trillion in total), and Warren wants to expand coverage to dental, vision, audio, and long-term care. Plus she's assuming some inflation in costs (3.9% per year). The $52 trillion is actually a conservative estimate—unless the change helps bring US costs more in line with costs in other countries. How much is our private insurance system driving the exorbitant costs of the American system?
5
@Florian
Yes, you are right, I think. Warren ought to look at how the European systems work.
Here employers pay some 14 % while the employees pay 8 %. At least that were the figures some 10 years ago. When retired I pay some 22 % tax and have to pay abt. US$200 a year before I have free doctor and medicine. Hospitals are owned by the state thus free.
But of course one may pay for Insurance additionally and that is a must when travelling abroad.
1
Democrats advocate new health spending to help the lower incomes financed by middle and upper incomes in the form of new taxes. Why wouldn’t lower incomes, who already pay no Federal Income Tax, endorse such a plan providing benefits at no cost.
What comes next ? Free college ? Funds to maintain minimum incomes ? Retirement benefits ? Free web/phone service ?
Where do the Federal handouts stop ? Eventually the middle and upper incomes might just run out of available funds. What happens then ?
17
@Peter I Berman
Warren's plan raises taxes only on corporations and very wealthy. You wouldn't see much, if any, change in your taxes unless you are making millions. You will, however, no longer have any health care premiums, deductibles, copays, or coinsurance. Most middle class people (including upper middle class people) would save thousands per year.
7
@Peter I Berman Americans spend more money than any country in the world in healthcare, yet America does not have the best outcomes. There are billions of dollars that go to health insurance companies for administration and salaries that would be better spent on actual healthcare. Why not save money by cutting out the middle man ?
3
Every human on this earth should have equal access to quality health care and education so they do not have to live in chronic fear and humiliation. (Which is what brought us Trump.) Many civilized countries have achieved universal house care and affordable education and yes, they knew when to "put a stop on it." Your view is alarmist and extreme. Wealth inequity is currently obscene in this country and a great deal of tipping the scales back in the other direction needs to happen before we are even close to the socialist world you seem to fear.
2
"Tax collections would increase through improvements to I.R.S. enforcement, which Ms. Warren believes could raise a lot of money. ($2.3 trillion)"
If they aren't already doing this now, what makes her think they can do it under her plan? I would think that she should have already forced Medicare and other government providers to enforce their regulations.
So she is OK with the lack of enforcement that is already occurring and has occurred throughout her being in the Senate?
4
I’m quite sure she is aware of the problem since she was a popular professor of tax policy at Harvard. So she understands both the opportunities and the pitfalls of tax changes. As far as her status as a a Senator, let’s simply note Mitch McConnell and Donald Trump run things in this country, not the Democrats.
4
@Bill ..."strengthening the I.R.S., which we know fails to collect large amounts of legally owed taxes, principally from people with high incomes, because Republicans have starved the agency of resources."
Paul Krugman, "Did Warren Pass the Medicare Test? I Think So," 11/1/2019
2
@Bill
The Senate doesn’t enforce the law. They make the law.
The Executive branch enforces the federal law.
So as President, Warren could instruct the justice department to place a higher priority on white collar criminal prosecutions. But because the legislative branch controls the purse, the GOP could simply starve the justice department and the IRS from funding which would make enforcing white collar criminal laws impossible.
So many people have no idea how their own government works. It’s so sad.
1
The calculations behind the Warren plan are extremely complex and depend on a variety of demographic and socioeconomic factors. Given this complexity, there is a high probabilitiy that the results will be wrong and the proposed system will not be solvent. The US healthcare system is a massive enterprise when taken collectively. If the Medicare for All plan does not work, it will be very expensive and difficult to put Humpty Dumpty back together again. A more catious approach is advisable.
20
I don't think the healthcare is working right now with ever-growing cost that drive more people out of insurance, because even with insurance people can not afford healthcare.
3
@Michael Yokell
What you said, “The calculations behind the Warren plan are extremely complex and depend on a variety of demographic and socioeconomic factors.”
What I read, “I think Americans are stupid and are not capable of implementing the same system that every other developed country has already used successfully for decades.”
Medicare for All isn’t an untested or radical theory. The rest of the developed world has used universal healthcare for decades. And their countries haven’t collapsed.
Will there be some growing pains? Yup. Will everyone be far better off? Yup.
4
What needs to be acknowledged, and I've heard no one address this, is that the US is not a homogenous population. Start and stop at the decades-long deleterious effects of income disparity and lack of any preventative care options for a large swath of our population. The result? The majority or near majority of the population is obese or morbidly obese. The implication of that alone has resulted in so many having chronic conditions such as diabetes, heart, lung, and inflammatory diseases, which are very expensive to treat, especially when neglected over time.
While I truly want a universal healthcare system, anyone who doesn't acknowledge the upfront costs of getting the majority of the population to even a baseline of wellness, is just blowing smoke and pretending we are analogous to a Sweden.
20
@zelda
Heavily tax the sellers of obesity generating foods to cover the health care costs their profit seeking inflicts on us all.
1
So, cut people from the healthcare is your solution of the problem?
@yulia
I don't have a single solution. It will take the will of Congress and for society to demand action to acknowledge need for preventative care, wellness awareness education, healthy food zones in poorer neighborhoods, planned parenthood opportunities with child care education, addiction treatment, addressing the opioid crisis--just for starters. And what are the chances of that?
My point is, I believe Warren and Sanders are vastly underestimating the costs of universal healthcare
A 6 percent wealth tax on estates larger than a billion dollars?
Quite an incentive for these mega wealthy people to move themselves and their corporations overseas. How many countries do not have a wealth tax? All of them. They would also benefit from lower capital gains taxes. Figure this would be the Irish-Cayman Islands-Singapore empowerment act.
The IRS would be taxed with a 2 trillion dollar enforcement tax exclusive of the wealth tax. How many entrepreneurs and small business owners would end up being persecuted by nasty tax audits? Would this kill the venture capital boom? In the U.S. you betcha.
Otherwise, the mandate to supply comprehensive and low cost or no cost healthcare including dental and other supplemental services will bring up questions of professional compensation. If the rates are current medicaid reimbursements then don't bother, all the hospitals will close and many doctors will start driving for uber (the new 15 dollar wage should attract them). If it is medicare rates, that too will be very problematic, it will also trigger a revenue crisis for a healthcare system designed to work on the higher reimbursements from private insurance.
Needless to the political obstacles against this plan may make it a nonstarter pie-in-sky failed legislative agenda.
What happens then Mrs. Warren? Where do you go with a massive failed healthcare agenda? This is not a Harvard Business School case study or a JFK School of Government scenario. What happens?
14
It’s true some rich and well placed hospitals and doctors may get hurt. But Medicaid pays a pittance and self pay even less. This all evens out. It will be a bonanza for most hospitals and doctors, and they wouldn’t have to fight any insurance companies and spend huge amounts of money on the collection side of the administration of trying to collect fees.
1
The US collects taxes from American citizens that live abroad as well. So, they will need change of citizenship to avoid taxes.
2
@Garbolity
You do realize the government contracts out with private entities to challenge payments, right?
I feel like people think that Medicare just processes claims, which is patently false. They have medical directors, they review charts, they recoup money, just like the insurance companies, only they can also refer you to the oig if they find billing irregularities. They pay less than commercial insurers on average, so I’m not sure I understand this bonanza you predict.
"A new financial transactions tax would be imposed on stock trades. ($800 billion)."
I believe this is the Tobin Tax after economist James Tobin, who first proposed it. The tax Tobin proposes is very modest, less than 1%; but it raises billions.
If that's so, why not make it 2% or 5%. Financial speculators might whine a bit, but I don't think many people will be getting out their handkerchiefs at that.
11
@Ambrose
When those evil hedge funds and "financial speculators" are doing high-speed trading all day, whose money do you think they are trading for profit? The Mr. Monopoly guy in the tux? Jeff Bezos? Warren Buffet?
No, that money is mostly your IRA 401k and pension funds for teachers, cops, civil servants, etc. So yeah, sure; you're just hurting rich people.Wake up and read
@GMooG
I thought my pension fund was invested in shares. Also we have ethical rules about investments.
I have no idea if Warren’s plan is feasible. No one really knows. Every enacted law has unintended consequences that have to be addressed. With such a massive undertaking the mind boggles at what the unintended consequences will be. Yes we have to do something about our healthcare system. What we have now is simply unsustainable. But this? I really don’t know. And I doubt we will ever find out. There is no way the Congress will consider such an ambitious plan, even if the Dems take the Senate. It’s not in our DNA to scrap an existing system and put a totally new system in its place. Even Social Security did not replace an old system. There was nothing before it. That made it easier to enact. I’m afraid we will have to work with what we have to improve it, whether Warren likes it or not.
14
@Queenie I am a strong supporter of single payer universal healthcare, to the point where I think it should be considered a basic right in all countries.
However, if the USA is ever going to have all its citizens covered, at all ages, and no matter what their employment status, there has to be a path from what exists now to a system that would cover everyone.
The costs of the Medicare for All plan seems to be calculated based on what it would cost once up and running, but how do you get there? Bernie Sanders suggests everyone be allowed to enrol in Medicare. Since Medicare, which operates largely without any budget for sales and publicity, is a much more efficient provider of healthcare than private companies, proponents of this idea seem to assume this efficiency could be realized, or even improved upon, should all residents be covered under the Medicare umbrella.
But this plan would see many thousands of Americans who work for private insurers turfed out of their jobs, and the Medicare bureaucracy would have to go on a hiring binge, and enlarge their offices etc.
Could there be a better way? What about the example of Switzerland, which had a fully entrenched private insurance industry, viciously championed by the right wing, when a referendum mandated universal coverage? (By the way, almost immediately once universal coverage was instituted in Switzerland, right wing politicians admitted it would be political suicide try to dismantle it.)
cont'd...
1
@Queenie (2)...Switzerland has a system which works something like this. Private insurers have to offer basic policies that cover everything the government deems to be essential healthcare, and they have to offer it at two prices, one for people under the age of 25, and one for people over the age of 25, regardless of pre-existing conditions. Swiss healthcare is not attached to employment. It is purchased separately, and if your income falls below a certain level the government will subsidize your insurance. Everyone is mandated to buy insurance, and low or no income people get subsidized.
cont'd...
1
Understand that the real objective of Medicare for All is that everyone will receive the same healthcare experience.
It won’t reduce overall costs - the government rarely increases the efficiently of anything. It won't improve the quality of care. By holding down the reimbursements to doctors and drug companies, the best and brightest will look for work in more rewarding fields - jobs that pay more and don't have the hassle of dealing with what will be a DMV-like bureaucracy.
What Medicare for All will do is drag down the average level of care for everyone. Expect long waits, little innovation, and mediocre providers. And we'll never know what we've lost. But at least we'll all suffer equally.
27
@Trench Tilghman These are the exact same arguments -- co;y and paste -- from the effort against Canadian single payer. And the bottom line there is that is costs 1/2 our bottom line, just like all the other first world countries that have single payer.
The only differences among these is how they approach health care within their own culture. Some have retained private insurance companies. Others are entirely nationally owned...
3
The Government is more efficient in holding prices down, that why the our healthcare is most expensive in the World. The brightest can try other fields of they inclined but this fields already have brightest, how many more brightest they can absorb without driving income in these fields down?
2
@Trench Tilghman Thank You!!! People think Medicare for All is some magic pill. It’s simply a way to get switch the burden of costs. It will do nothing to reduce the overall costs.
1
I truly hope Warren is not the nominee. I will vote for nyone who is not Trump. I will also be very angry at the Democratic party. Clinton, then Warren! Absolutely unforgivable.
21
@Ed What are you one of these guys at the health care trough -- making at least twice what you would earn in any of the first world single payer systems?
Sure sounds like.
1
@Ed You neglected to tell us why.
1
They are giving us no option but a bunch of unelectable socialists who only want to put their hands in someone else’s pocket. The solution to every problem isn’t having someone else pay for it.
According to the Census Bureau, 8.8% of Americans are uninsured. To correct this inequality, Sen Warren proposes to relieve the vast majority of Americans of their private insurance. But as we speak, the best doctors are quietly stepping away from Medicare because the reimbursements they receive are inadequate. The fees have been squeezed to pennies on the dollar.
If we should be so unlucky as to be forced into Medicare for All, a two tier system will emerge. The wealthy will see the best doctors and pay cash. The rest of us will be in a very long line waiting for service. The VA system is Medicare for All. Look how well that has worked.
Medicare was created to serve the senior population, the widow and the orphan. It was never meant to deal with the general population. As it currently exists, it could go bankrupt in a couple of years. When hundreds of millions of new patients are added to the rolls, it will be incredibly expensive.
Sen. Warren has a plan for everything. Trouble is she is an academic and her world exists in an incubator for theoretical issues. In the immortal words of Mike Tyson: "Everyone has a plan....until they get punched in the mouth." This could be a $52 trillion punch.
27
@Madalyn973 Is the Consumer Financial Protection Bureau ("CFPB") theoretical?
30 million consumers, to whom $12B has been returned since the bureau's inception, are likely quite pleased that Elizabeth Warren FOUGHT to make it REAL.
7
How come that 'reasonable price' in the US twice higher than in any other places?
2
The idea is simply comical. Spot on about Warren’s plan for everything- anyone’s who lives in the real world realizes it’s pure fantasy.
1
How long can this continue?
National health expenditures from $2.5 trillion to $3.5 T from 2010 to 2018, according to the Altarum Institute, who publish these numbers every month. Up 40% in 10 years. Real per capita health costs have gone up from $9,500/yr to about $11,750 in ten years. NHE has stayed at about a constant 17.8% of GDP for three years.
Something will break, and the poor and lower middle class will pay the cost by going without health care. Life expectancy is already decreasing in the US. What more warning do we need?
7
@Gentler Mayhem
And, we are already paying for that. Uninsured people receive emergency care, and insured people are overcharged to compensate for the care of uninsured.
On top of that: "it is not about the revenue that American doctors, hospitals and drug companies have become accustomed to earning"—as the author said—but about what they steal and rob.
2
@oo7 - emergency room care is no substitute for regular care from a primary care doctor and seeing a specialist when necessary. Nor do ER
visits cover medications, physical therapy, mental health counseling and more. It's not even remotely close.
1
We all know it will me massively expensive and cause a huge disruption to implement.
The GOP will label it a massive government takeover.
Running on M4A would make what should be a rather easy victory against Trump, a probable loss, since independents in swing states (went for Trump last time) may think the status quo is at least a known commodity. I mean, they voted for him in 2016, even with his bad behavior then.
Would M4A it be beneficial in the long run?
I think few would argue that it would not be, however it is simply about how one chooses to get there.
The simple fact that is that there is no need - at all- to do this in one fell swoop like Warren wants to do and risk losing the election.
The moderates' plan for a buy-in can get us to the same place, is less disruptive, and is so popular, based on a Kaiser poll, that it is actually a winning proposal - people in both political parties like the idea. In addition, Warren is unlikely to get M4A through the Senate even if she won.
So, why take this risk? It makes no sense.
When you combine this fact with the fact that we actually have a far more pressing issue - climate change - the idea that Warren is risking losing the White House with a huge and unnecessary proposal - is very upsetting.
She has to know this increases the risk she will lose - but seems not to care.
I care.
We can't risk 4 more years of Trump, we have to address climate change - now!
11
This is exactly why I support Joe Biden. Successful transformational change is accomplished in thoughtful, well planned increments, not cooked up in a few weeks. It also must have broad buy in, which MFA never will have. Biden’s approach is to take the Affordable Care Act to the next level to broaden coverage and offer voluntary buy in to government plans. Far more sane and palatable.
2
@Meg
Here is the Kaiser Poll
Public Opinion on Single-Payer, National Health Plans, and Expanding Access to Medicare Coverage
Published: Oct 15, 2019
https://www.kff.org/slideshow/public-opinion-on-single-payer-national-health-plans-and-expanding-access-to-medicare-coverage/
Yes! The Canadian health care system is due to go broke with just 2 years after its inception -- 1966. So, it's been in the morgue since about 1958, eh? Answer - invest in morgues!
And how about our Medicare system, doomed from the beginning in the 1960s, which has only added a miserable 20 some years to the average life span? And it's surely gonna go broke too! Answer -- more morgues!
The only solutions is soylent green with special sauce to reduce the pain and suffering of the old and sick. Well, you know the answer to this one.
-We cannot afford to NOT institute radical reform. This wealthiest nation diverts a third of 3.5 trillion $/yr spent on "health" costs in non-medical related waste. Do readers think that the Japanese, Europeans, Canadians and rest of the developed world not undergo as many visits, MRIs, joint replacements, organ transplants? Do readers think it fiction that our life expectancy trails those nations, but spends twice as much for these inferior outcomes. The misguided effort to apply free market models to the asymmetrical medical "transaction" has resulted in the ridiculously overpriced procedures, diagnostics, and medications we now encounter in our daily anxieties over affording healthcare. -Nonsense that innovation will falter:Marketing/ads and profit, often for "me-too drugs," far exceed research that BigPharma makers do, while "safe-harbor" legislation excludes them from antitrust consumer protections. The pipeline for innovation will continue to arise from publicly funded research.
-US docs are burdened by a free for all of non-uniform insurance/formulary policies directed towards insurance profits. Administrative costs are absurd. Good docs will still enter medicine if they get paid "medicare rates." Docs don't (and should not) enter medicine on the motivation to make what CEOs earn. Rational health policy would incent training costs exchanged for service in underserved areas, and emphasize a primary care approach, rather than hospital-corporative-centric focus
7
@KD
Thank you. Cogent AND correct.
1
I have Medicare and pay $138/month for coverage. Does Senator Warren’s plan include this contribution for all? I haven’t read a word about this.
9
This plan reminds me of the old joke that asked how do economists manage to leave when stranded in a deserted island. They assume a boat.
15
Remember she also has other very expensive plans she is offering as part of her campaign. The sheer amount of change she is suggesting is a clear non starter for most of America. The unknown unintended consequences of these systematic overhauls are not even given a thought. What if these billionaires leave the country or find more loopholes ?
This is Academic though. The Dems moving forward with their impeachment with ZERO Republican support in the House will ensure us 4 more years of Trump.
Plus the inevitable recession Paul Krugman has been salivating for is likely to arrive at some point if history repeats itself.
The Dems should abandon all these pie eyed ideas and just run on restoring decency and dignity and repairing our standing in the world.
Swinging the pendulum back 180+ degrees in the opposite direction is no way to win in a deeply polarized nation.
18
A scary article. Lots of assumptions and little in the way of actual implementation.
Even Dr. Krugman knows it cannot happen in this way.
15
Warren and Sanders have the courage to say, "cut defense spending and increase taxes." I get that the wealthy, defense industries, and the military will vote their self interests by supporting other candidates. But what about the rest of us? Why would we want to stay the course of engaging in endless conflicts with no success criteria and repeated tax cuts for the wealthy?
5
@maqroll
Total projected defense spending over the next ten years is 7.886 trillion.
M4A, is projected to cost 32+ trillion or 4 times the entire defense budget.
The total projected spending, outlays for our government over the next ten years is about 57 trillion.
Thus we are adding more than 50%.
I think people don't understand how massive this proposal is.
That is the reason I support the moderates' buy-in plan. It gets us to the same place in a more gradual way.
However, the most important point is that it will be much harder for Warren to win the White House or the Senate with such a plan and should she win, it is not even likely to pass the Senate - so why do it?
Why take the risk when when have to win to fight climate change - now?
We have to win.
We can't get anything done if we don't win. Running on M4A is simply a bad idea.
9
@Meg
You are wrong when you're claiming that Medicare-For-All is not affordable.
We are already spending at least $3.5 trillion per year (as of 2017). So, multiply this by 10 and you get to $35 trillion.
It is a simple arithmetical operation, increase the Medicare tax employees and employers pay now and eliminate the premiums, the deductible and the co-pays that covered people pay nowadays. The result will be a net savings. So, even though the Medicare tax will go up, in the end every family will have a savings and it will be like a tax-cut.
6
@George M. Nobody who actually runs the numbers agrees w you.
It's clear that this is the rosiest and most optimistic scenario for funding Medicare for All.
In the near certainty that all these optimistic assumptions don't all fall into place, costs will be higher, and those costs will be borne by the middle class.
Of course it will never pass to begin with, so anyone voting for Warren (or Sanders) with the hope that she'll deliver Medicare for All may want to look at other candidates with more sensible and doable proposals. Amy Klobuchar comes to mind.
4
Here in Canada, we all get free Universal Medicare, no matter our income. We pay for it with SALES TAX.
10
@Em Chase
I don’t understand why so many Americans are okay paying insurance companies high premiums and deductibles and co-payments but somehow having to pay the government the same money is somehow bad. I am also a Canadian and we can see a doctor as many times as needed and don’t have to make a excruciating decision between buying medications and paying for rent. We don’t mind paying sales taxes and other taxes because we get free health care. It is worth it!
12
@Nina It does seem a mystery.
Could it be that they do not understand that their out of pocket medical costs/expenses will be greatly diminished or disappear?
Might it be they fail to comprehend that they'll no longer be fighting with insurance companies about such things as pre-existing conditions, emergency room visits, out-of-network providers, etc?
Is it possible that the pervasive marketing of the medical industrial complex has been so effective, as to cause them to believe that the alternate reality that successfully exists in most other industrialized nations, would not possibly succeed here?
It does seem a mystery.
3
@Em Chase And those who can afford it come to the US for their healthcare. I wonder why?
1
The fundamental takeaway from this article is that Warren is making a considerable amount of assumptions when it comes to "paying" for Medicare for All. While it is unequivocally necessary for America to implement universal healthcare for its citizens, we must do so in a way that will a permanent and successful establishment of the program. Warren's proposal frequently comes across as overly optimistic and dismissive in multiple sections.
Comparing her proposal to a candidate like Andrew Yang's demonstrates significant differences. Yang believes in M4A, but rather than the abrupt and immensely expensive shift to universal healthcare Warren backs, he understands the magnitude of such a monumental change to America's citizens. Making the government's healthcare aggressively competitive with the private sector will provide a much better path to success.
5
@Alex "The fundamental takeaway from this article is that" people are afraid of a change.
The system is broken, the ship is sinking. We will bleed to death without radical change, and ability to constrain greed of people who currently benefit from this system.
2
@oo7 Yes, Democrats need to respond to the destruction wrought by the Trump administration by proposing aggressively progressive policies. But this must be done in a way that can be achievable. This is why I mentioned Andrew Yang. People say his UBI proposal is unrealistic, but compared to Warrens $30 trillion M4A stance, UBI can be paid for by easily recognizable sectors of our economy, and would get bipartisan support due to its ability to help rural communities.
Yang's approach with UBI is mirrored in his M4A stance. Rather than the immediate "all or nothing" approach by Warren, Yang understands the need to create concrete reform that will stay into the future. While Democrats are eager to achieve victory in the wake of Trump, we must do so in a way that gives permanent success and not a temporary high.
Here's the only math that matters:. take the total amount of money spent annually in the United States from any source on healthcare today, subtract the cumulative amount of money health insurance companies profit, add 25 percent of the payroll expenses for those cumulative companies (people who will be required to support Medicare for All - far fewer than are required now through 50 separate insurance companies), subtract $2 trillion by implementing a standard pricing system that applies to every provider, period, add the cost of ensuring all the people who are not insured today (???), subtract half the cost of malpractice insurance (cap punitive damages at $100,000, remove "hit the lottery" syndrome from medical malpractice suits), add new taxes on the mega wealthy, add double Medicare tax, and you will find out if Medicare for All will work. Just based on available numbers Medicare for All it's a slam dunk for success. But Democrats have to give ground on punitive damages for medical malpractice suits and Republicans have to realize that whoever is paying for healthcare today will continue to pay.
3
So sick of corporate Democrats who preserve their own well being and refuse to make or embrace changes that help the People. The GOP are simply beyond corrupt and cruel. Go Warren and Bernie and Corey, etc.! We want change and know it won’t happen overnight and will take work but we want those programs to begin NOW!
7
Ugh, this is electoral suicide for Democrats.
She says aim high and work hard, but instead she's aiming at our collective foot and won't stop pulling the trigger.
She's on an electoral suicide mission and I want no part in it. We must defeat Trump and anything that gets in the way is foolish.
13
You are correct. People who have worked hard to get jobs with good health insurance and in some cases sacrificed to get it or keep it (like staying on a job when they would leave if not for the health insurance) will revolt against this plan. Warren should just write a check to Trump 2020 and be done with it. If Warren is the nominee with a plan to take away people’s health insurance, Trump’s re-election is secure.
11
@Jackson Belt
IT IS NOT A PLAN TO TAKE AWAY PEOPLE'S HEALTH INSURANCE.
It is a plan to make health insurance a lot simpler and less painful AND to provide universal coverage.
Trump and the GOP are offering NOTHING.
2
Thai nonsense gets us 4 more years of Twitter man. I wonder what I would do if she is the nominee. I already pay 50pct of my income in taxes. When does it end?
Assume away Lizzy but will assume all your assumptions are pie in the sky. The kind that is made with our dough.
5
I am not sure Americans even want anyone but a total crook and a supremacist in the White House (40 million or so couldn't care one way or another, and would rather not quit staring into their cell phones). The evidence that Americans do not want free healthcare is plain overwhelming.
Since the time Hillary worked to produce socialized healthcare starting 1992, we have enough evidence to suggest that for Americans - the notion that some people (blacks, browns, immigrants) could derive a benefit that they might be paying for - triggers a hysterically negative response.
Now add to this that Warren is exactly the opposite of Trump in a way that America does not embrace. She is cerebral, articulate, specific to a fault, genius level IQ, professorial, empathetic, human, and has led an exemplary life. She is decent, understands the challenges of ordinary people, and knows what makes families go bankrupt. She has made no point of identity politics.
All this makes every white person outside of city center reject her violently. American women - who are singular when it comes to not supporting other women - will find some fault and not vote for her. My hypotheses from listening to women who support Trump is that he is the kind of guy they wished they had married so that with his money, they could lord over other women in their lives.
I am voting for Warren in the primary and in November 2020 if she makes it. I suspect I am the minority.
13
“Unrealistic, given the revenue that American doctors, hospitals and drug companies have become accustomed to earning.”
This is an amazing sentence really. Somehow we never see such sentiments expressed when politics proposes to take money from the poor. When various welfare reforms literally made people go hungry there weren’t NYT articles saying “... unrealistic, given millions of poor Americans have become accustomed to eating three meals a day”.
16
LOL--State and local government as a new source of revenue?
Please.
IRS enforcement? Really?
3
Seems that this plan would actually provide more freedom for businesses and workers by transferring the responsibility for financing health care to the federal government, the only organization large enough to truly take on the risk of insuring health. I’d imagine that individuals would still be able to purchase supplemental insurance as current Medicare enrollees are able to for those fearful of not having access to specialty health care they’re willing to pay for. Locking in fee-for-service rates at a multiple of current Medicare rates is a fear for hospitals and health care providers, but this would potentially accelerate the shift towards from volume-based care to value-based care like surgical bundles and universal primary care.
4
This is all so depressing to me...why can't we just focus on beating Trump instead of taking a potential suicidal risk at this time? We still don't have a successful Obamacare running; let's focus on this and try to bring moderate Republicans and Democrats along.
Warren will not beat Trump. She will isolate her liberal followers just as Trump isolates his Trumpers and a whole heck of a lot of moderates of both parties will be lost.
15
@Dolly Patterson
Did it ever occur to you that the Republicans took just as big of a risk with Trump, and won because of it?
Moderate Republicans don't belong in the Democratic party any more than moderate racists do.
When you stand for everything, you stand for nothing.
5
She is completely unelectable. Period. Upper middle class Dems will keep their mouth shut, go into voting both and vote for trump. And then deny it.
@David Westcott
I was going to write the same. You are right, we, in Western Europe, enjoy Medicare for all and our standard of living is very good. The main reason that you should be afraid that it won't work in the USA is because you have let the neo capitalists take over. Do spelling about it!
6
Math? Math?
It is patently illogical to hold the view that math-derived arguments appeal to anyone in America. Similarly illogical that anyone can process anything beyond a micro-second; or knows from hard and soft evidence.
Warren wins if people believe incompatible things about her, as they have believed about republicans to produce enduring republican victories in all things local, regional, state and national.
That is, the belief that she (like republicans) will direct the federal spigot into their pocket selectively based on a tribal membership and identity test, beggar, shoot and imprison black and brown people, make sure that white collar crime continues unabated, and that the future of our kids is drained to ensure gramps gets Viagra and hip free hip replacements in his 90s.
If Warren wants to lose dramatically, she would have to speak of her plans and her math.
She is plain better off telling Americans that she is going to lock up every single white collar criminal, starting with Trump, Moscow Mitch, and his minions (including media personalities that spreading hysteria).
3
Every private health care provider, every private insurance company, every drug company is under pressure to increase revenue for stockholders and executives. Raising costs to patient, or in the case of HMOs denying essential care, means more money for them. Why is medical care so expensive? Because that's our goal.
Warren is the first candidate of either party to spell it out. Competition does not work in medicine because every provider has monopoly power and every patient is powerless. Unless you are a decision maker, then you magically get a Rolls Royce plan.
The only solution is Medicare for all, and I don't mean Medicare disAdvantage, which is just an HMO. Medicare Advange plans make money by denying care, and by making it impossible for providers that care to even get on their plans. Get US government Medicare and then get a supplement if you need it, but don't compromise your right to the care you need.
8
@Dan Woodard MD Oh I am so overjoyed to read your comment. It means a great deal coming from a Doctor!
5
Simply getting rid of health insurance companies won’t make up savings. The health insurance industry made $23 billion in net profits in 2018. That amount is a rounding error compared to the $3.7 trillion in annual health care spending.
Health care is also people intensive so cost cutting is coming from them.
You can’t make doctors, nurses, hospital and physician group administrators, anesthesiologists, pharmacists take a lower salary or somehow cap their earnings.
You can’t make pharmaceutical companies make new medicine. The only reason why they innovate at all is because the USA provides them their outsized profits. The rest of the world free rides on this.
You can’t make wealthy and those with high disposable income to use private or foreign health care. Health care disparities would continue.
I would focus on subsidizing health care for the 28 million Americans who can’t afford health insurance due to low wages. Focus on preventative care by getting everyone in front of a doctor 1-2 times a year.
Not by creating a behemoth health care system that could become a colossal failure of epic proportions. The USA, and its state and local governments, has NOT demonstrated its capable of running a competent government service program that doesn’t look stale, slow, outdated or reek of the stench of stale urine.
Voting Democrat should be a slam dunk with these Inner Party fascists in the White House and Senate. Democrats are trying their best to make this difficult
9
@Practical Thoughts I wish you would read her plan and Bernie's plan and stop believing the propaganda that the insurance companies are trying to scare you with, via the politicians they pay. Other countries do very well, are you saying the US is not up to snuff like all the other civilized countries? Don't you feel ashamed to be having been left behind by those countries. Wow maybe the US is a third world country, I know are medical outcomes are more in line with the third world, especially women dying in childbirth. Gee our education is in the john too. Well I guess we are not great after all. And certainly our wealth disparity is on par with dictator run countries. Thank goodness we have two progressives in the lead trying to pull us out of the third world hopelessness. And read the polls most of America is progressive and wants Medicare for All only the corrupt do not want it. And you of course.
6
I am traveling in Italy now where the admittedly inept national government manages to deliver health care to all residents and pay for most college costs. Per capital income here is HALF that of the USA. Situations are similar in all industrialized countries. Your arguments about the US government’s inability to do this are just wrong.
5
@cheerful dramatist,
First, 25 million have no insurance. It would cost $250 billion to fully subsidize them. Why not just start there. Much lower cost and easy to implement.
To answer your question...no, I do not believe the USA is capable of delivering public services as efficiently and effectively as other Western nations. We are elite when it comes to military, state department, treasury and intelligence/law enforcement. That’s because we fund it well and society looks favorably to them. The training in those groups are elite.
When it comes to human services and infrastructure, we are not competitive. We have more corruption that steers contracts to do nothing companies. Moreover, government services, like K-12 teaching or Amtrak, has a negative image in the USA. In other countries, government is seen as an aspirational career choice. In the US we don’t consistently find public efforts and have a struggle doing so.
Our infrastructure is junk, schools are junk, VA is junk and our aviation and food regulators are junk.
By the way, half this country are made up of Outer Party fanatics that hate public spending.
For all of those against Medicare for All, you come up with a solution to give us universal coverage.
All the other first world countries get some form of universal healthcare, why can't we.
We are the richest industrial country on the planet GDP / capita.
But we have parts of the US with infant mortality rates of a second world country.
In addition, we spend twice as much per capita and twice as much percent GDP for healthcare as the other countries.
So while you are at it, if you can get lower our cost, that is welcome, too.
Instead, all we get are excuses.
And I have not heard any Republican voter, Tea Party person, or evangelical who wants to give up their Medicare.
5
Here you go.
Step one: Focus first on those without health insurance. Separate out those who choose not spend their disposable income health care.
25-30 million have no health care. If you subsidize them 100 percent; it would cost $250 -$300 billion.
Step two: Reduce liability costs. Reform what is subject to lawsuits. . The malpractice insurance is ridiculous. Possibly the US could nationalize malpractice insurance and minimize the cost.
Step three: Pass a law mandating that drug prices cannot be more than 5 percent higher than the same drug sold in Western Nations. Moreover, all drugs sold in developed nations must be made available here.
Step four: Provide tax incentives or penalties to companies that provide or don’t provide insurance to those making under $50K per year.
Finally, give a credit to all people who visit a doctor at least once per year. Full preventative care would reduce our health expenses. This is why other countries do better. More of their people see doctors.
Also, better food labeling, restrictions on smoking and gun control would also measurably reduce costs.
Lots of complexities here. Just one comment from me: where is a VAT?
1
VAT (aka sales tax) is very regressive. Warren’s plan puts the burden where the money is: on the ultra rich and corporations who are already footing the bill.
2
@Jane Scholz
I don't know about "very" regressive." It is regressive, you're right, but very efficient in many ways. A good tax system has a VAT (almost every country in the world does, including champions of welfare states such as all three Scandanavian countries, Germany, France, etc etc.) and counteracts the regressiveness by income taxes and various kinds of assistance to the poor. E.g. universal health care.
The US continues to ignore various lessons from other countries, to our cost. The absence of a VAT is one of the most egregious.
When compared side by side with the GOP plan, Warren's plan is.... WAIT! GOP does not have a plan! Duh.
5
@Scientist The current system is fine by me.
2
Senator Warren’s “plan,” reminds me of the rosy scenario usually required to sell phony numbers. Sanders and Warren share the problem of offering free pony public policy to a credulous fan base. Reforming and improving what Republicans labeled Obamacare, and introducing a modest public option is the only way from here to there, even if you assume Medicare for All is a place worth ending up at.
2
Wake up. The US is the only major industrialized country without universal health care.
3
The irony of Warren’s plan for reparations for gay couples is that most trans people — the most marginalized group in the LGBT umbrella by far — would be shut out of this due to the high rate of poverty and dysfunction in the trans community. Trans people typically have immense trouble dating and partnering generally. This would be reparations for a group that is already largely societally accepted and which is statistically more prosperous than average.
A real life example is that of my own life: as a trans person who was the victim of a violent hate crime after Trump’s election, I would get nothing. And I’d be taxed to pay extra to people like the wealthy polyamorous gay couple for whom I used to be a plaything on the side. Forgive the explicitness of that description, but there are times the reality of things needs to be acknowledged. Her policies have evolved from wishful thinking into something... else. It doesn’t all seem right to me.
2
Here is some relevant information, perhaps explaining why Canadian health care works:
https://www.bbc.com/news/world-us-canada-43336410
In short: doctors are still highly compensated (making around $300k on average), and have considered turning down pay increases to help shore up other aspects of the health system.
1
@Dan
In reality, doctors haven't "chosen" to turn down pay. They were forced to because the healthcare budget was cut.
All doctors are part of a union in their province. The pay they receive is negotiated at the provincial level with the provincial government. In many provinces this has resulted in mass shortages and forced closures of emergency rooms because doctors wound up leaving.
Specialists receive $300K on average, not general practitioners which make up the vast majority of front line healthcare workers.
4
No one cares where their healthcare costs are taken from, be it my salary, my savings or my taxes as long as my care cost is lower and comprehensive. This obsession over higher taxes is a construct of the for profit system and their political beneficiaries.Why do we pretend that this is the sticking point. Our healthcare costs right now are ELEVEN TRILLION every ten years. How did otherwise decent and intelligent taxpayers believe that the US just can't manage to serve their citizens? should we continue to expect war and crumbling infrastructure, pollution, corruption and little else, this is like national suicide.
4
Why is it considered so "radical" to want to save money on drug costs, administration, and then to impose new taxes on the very wealthy? Why is everyone forgetting that:
1) premiums were going sky high before the ACA,
2) workers were tired of being chained to their jobs due to employer-based insurance,
3) insurance was not obtainable due to insurance company refusal, such as pre-existing conditions and other rejections
4) lifetime limits were imposed,
5) and there was no protection for children up to age 26?
What about all the paper work in the current system, its resulting employees needed to fill it out, and patient confusion, refusals and paper work hassles for approval?
Come on, America...don't let that little fear button make you embrace a seriously flawed system. We can do better!
5
@Srose You're forgetting that when European countries started taxing the wealthy at much higher rates, they moved elsewhere, the revenue never materialized and ultimately the policy failed and was repealed.
Having a public Medicare option people can buy into creates portability and is available for all. It also has the advantage of being passable with a slim Dem majority in Congress and is realistically doable, unlike Medicare for All.
3
Actually, about half the countries that added a wealth tax still have it. And there are significant differences between Warren’s plan and the way many European countries implemented theirs.
3
If younger Americans are mostly approving Warren’s and Sanders’ plan to burden taxpayers with additional tax for Medicare for All, the young people appear to be too ignorant to figure out that there would not be a “net” benefit for them but only a tax increase since many of them in the 18 to 26 year age group do not have healthcare insurance costs sine many have coverage through their parents, but will see their taxes go up. Even the next age group of 27 to 35 wouldn’t have a net benefit since many are healthy and do not have much in out of pocket medical expenses.
2
I used to be a Hospital Care Investigator - a job that required and helped patients figure out how hospital bills would be paid - Insurance, medicare, medicaid, out of pocket.
What a tangled mess! I would welcome Medicare for All, an ambitious but doable plan.
4
This quote just is infuriating "Other health care experts call the ideas unrealistic, given the revenue that American doctors, hospitals and drug companies have become accustomed to earning." It is NOT doctors' earnings that is the problem: the problem lies with large hospital corporations and MOST OF ALL with ridiculous prices of medication in the USA. When my daughter broke her arm, the doctor was paid $100 but the hospital charged over $2,000.....please stop perpetuating the myth that doctors are overpaid. Keep in mind that doctors are professionals who trained for years and actually deserve better pay thsn they are getting.
33
I support Senator Warren because I feel she would make the best president out of all in this field. However, I think single payer is a born loser, and will be the boat anchor that drags down her campaign in the general election. Single payer polls horribly once people know the details, and there is one large thing about it that no one talks about--Stress! If passed, single payer would be a massively stressful experience at a time when the last thing any American wants is more stress. But will it ever happen? Imo, single payer would not even pass the Democratic controlled House right now. What makes any one think that this fantasy will pass Congress even if Warren is elected? So the only lasting effect for this proposal will be the negative effect on Warren's campaign.
Why oh why can't we discuss, and implement, what they have in Western Europe? They have popular plans that are based on the corporate structured, workplace centered models that ban excess profits, and turn the health care industry into a tightly regulated kind of utility. Find a way to take existing consumer costs and higher taxes on the wealthy, and plow them into a system that eliminates massive deductibles and co-pays (and requires drug companies to negotiate with we the people on costs), and the American people will thank the candidate who does it.
And for all of the owners of our existing system who want to make obscene profits off of our health, we say simply--Get thee to a hedge fund.
2
Bill for President!
Single payer save money? We have a no out of pocket plan now, it's called medicaid. I know people on medicaid that go to the emergency room for anything, because it's free to them.
3
Exactly. And if you saw the medical charts I see for ED visits, you’d scream: ear infections, flu, and even common colds being treated in the least efficient and most expensive way possible.
6
@David. These people will still come into the ED for those problems even with insurance. We are talking about a group of people with little self-control and ability to show up on time for an appointment.
1
I think the corporate media are having a harder and harder time convincing people that it is doctors who will bear any onus in Warren's plan - or workers with employer sponsored plans.
Anytime we go to a doctors office we count one dozen employees working in the office before we see the doctor for 10-15 minutes and just think of the corresponding number at the insurance company office (altho I admit I've never managed to speak to one that wasn't automated to say "thank you for holding").
Have doctors considered that malpractice insurance will go way down when lifetime medical care for plaintiffs is no longer an issue in court?
Warren's plan is the best thing that will every happen for enterprising, corporate, professional America.
The question isn't whether or not Warren's plan saves everybody money - it's how to make it work really well. Will the special interests ever allow that to happen?
3
@Excellency
So are you saying that under “Medicare for All” there will be no accountability for doctors who make mistakes or are careless in their work resulting in death or serious damage ti patients?
4
Will Medicare for All allow malpractice?
Of course not!
In fact, having all the doctor’s patient records in one place will make it easier to spot a bad doc. And that doctor will not be gotten rid of by passing him/her along to the next hospital with a clean recommendation.
@Sirius
No, I am not.
I am really curious how exactly the “top 1%” of earners, who are supposed to pay annual taxes on the investment appreciation, are defined under Warren’s plan. Haven’t seen this point elaborated anywhere, including at Warren’s website.
2
There are plenty of arguments written below, some for and some against Medicare for All. For me, the bottom line is that many other first-world countries have health care for all as well as vibrant economies. Many of their citizens also have longer average lifespans than Americans which suggests their healthcare is more efficient than ours.
If you believe in a free public education as a basic right for all our citizens, how can you not believe in Medicare for All as a basic right?
It took a Democratic president to propose and implement the New Deal, it took a Democratic president to propose and implement the Voter Rights Act and the Civil Rights Act, and it will take a Democratic president to propose and implement Medicare for All.
355
@David Westcott The president you are siting, FDR, is the one who helped create this whole mess. He put wage freezes in place during WWII to keep inflation as low as possible. Yet companies still had to compete for workers, so fringe benefits such as employer-provided healthcare become part of total compensation.
Would the American system of intertwined employment & insurance coverage exist without this? Can't argue counter-factuals, but lets not ignore the unintended consequences of the New Deal and their persistent impact into policy.
9
@David Westcott
"Many of their citizens also have longer average lifespans than Americans which suggests their healthcare is more efficient than ours."
No. That is a fallacy.
Many other factors affect life expectancy and until you evaluate the effect of those other factors you do not know the effect of our health care on life expectancy.
Let me give you an example for thought.
Life expectancy in Canada is about three and a half years higher than ours. In the UK it is roughly two and a half years higher than here.
Now, consider that in the U.S. women live six to eight years longer than men. A difference distinctly more than found between U.S. and those other two universal health care countries.
Using your argument it would imply that women get significantly better health care than men get in this country. Now, I find that hard to believe.
So there goes the idea of health care determines life expectancy.
6
@David Westcott With a free public education, you can opt out - and many do. With Medicare for all you can't. Very different than medicare if you want it. Also, most first world countries allow supplemental healthcare.
12
I think Ms. Warren's ambitious plan is completely out of sync with what most Americans, and will give ample fodder to her Democratic rivals as well as Trump, if she made it to the nomination.
As a moderate Democrat, I don't think most Americans want free college with previously incurred debt forgiven, free healthcare for undocumented migrants, open boarders, higher taxes and on and on. What I would like is for the Affordable Care Act to be put back on the rails; our commitment to renewable energy and reduced reliance on fossil fuels strengthened; rejoin the Paris Accords; an immigration policy that allows seasonal workers to flow freely across our boarders as they did 50 years ago before we had an immigration policy and most importantly some common sense in our political thought and discourse.
234
@Jack Moon I agree about not forgiving student loans. I wrote to Senator Warren and told her that lowering monthly loan payments would better, suggesting that with a million people in default, just requiring $50 a month would raise $100 million a month for other students. I hope she was listening.
10
@Panthiest Math mistake: $50 a month from a million people in default would put $50 million a month back into the pot.
8
@Jack Moon While I agree somewhat with your concern expressed in sentence one - the rest makes me wonder whether you're watching too much Fox News. Where does free college, free health care to illegal immigrants, all debt forgiven come from - not this article. And what the heck do boarders have to do with anything. If you meant borders - well they still are not relevant to the proposal discussed here. And do you actually have a problem taxing billionaires and wealthy investors to help pay for it? BTW - the only higher taxes the middle class will see is caused by increased wages, income and consequently higher taxes since healthcare premiums paid to employer' insurance plans are not taxed.
36
I don't know what Warren is talking about. Those on Medicare already paid into that system all their working lives and it still covers only 80%. So how does she expect to obtain "free" Medicare for all without taxing everybody? There are not that many billionaires in the country. Furthermore, most countries with socialized medicine have high tax rates. And while all will treat acute conditions immediately, there are months of waiting for chronic conditions such as diabetes, heart disease and cancer unless one accesses private care. And finally, if reimbursements are lowered, hospital care will flounder and provider care will worsen. People enter medicine to help as well as get paid well. They go into debt, take long years to train, endure huge stress and sacrifice. If it were only for the money, they could enter other lucrative professions and industries. Great Britain imports providers because no one there is willing to do it for their low pay. But no one talks about that. Sorry, but as far as I am concerned, "You get what you pay for."
4
It sees like this is the best long term plan.. Sanders and Warren are correct in that. The real problem seems to be the republican party and their insurance buddies. They will obstruct and be terrible negotiators. Their talking points are all over these comments.
Like what happened when Obama was trying to pass the ACA, the republicans and the insurance companies confused the issue so much that people were crying about taking away their medicare, while railing against an expansion of those policies.
And even if we finally create a universal system, will the republican party destroy it, like they have attempted to do with the current ACA? The answer is yes since they will again be advocating to line the pockets of their wealthy constituents.
Universal healthcare is long over due. It will need to hurdle a lot of obstacles, even after a shift in politics. The biggest obstacle being the propaganda of corporate insurance companies trying to maintain their profit stream.
@MC
The Republicans and their insurance buddies?
The insurance industry owns both sides. When you are big and powerful you don't risk your position on the whims of the voting public.
Just look at what happened in 1993 and 2009.
Where are all the savings? Even with massive cuts to drug prices this only amounts to a total healthcare cost savings of less than 3%. That’s it, less than a 3% savings with Warren’s draconian cuts to drug company pricing.
Also, the assumption that administration costs would be just 2.3% is just a ridiculous assumption, if one considers that insurance companies will no longer be doing any of the negotiations with providers along with fraud detection, etc. for Medicare, just begs skepticism. Today, Medicare is spending 6% on administration even with insurance companies doing an enormous amount of Medicare’s legwork. Warren’s plan savings are at best insignificant and at worst ephemeral.
Let’s get real for a moment. Germany, France and Great Britain spend 50% per person less on healthcare and they cover everyone, get better medical outcomes and their populations live longer. Not only that, but their median populations are older, meaning on paper more expensive to insure. Median age U.S. is 38 and in Germany it is 48. Based on that alone Germany’s healthcare costs per person should be much higher not much lower than the U.S.
Where is the plan to get U.S. healthcare costs and outcomes in line with the major civilized world, the world our economy has to compete in? It surely is missing from the Warren plan.
7
If she were truly "ambitious and assertive" she might want to consider that middle-class tax hike, like Bernie. And this wouldn't even be such a problem for the general election, since "middle class" for Democrats is probably "upper class" for most Americans.
6
@carl bumba No one ever defines either one
@Jackson
Yes, I know. I put it in quotes (maybe wrongly) to indicate the PERCEPTION of the classes among Democrats versus among Americans, as a whole (who generally are not as wealthy and educated). This is more important for the politics of the issue. The American people would probably be OK with taxes on the (upper) middle class, if it weren't for the professional class spinning it as a tax on the working class... who it wouldn't touch.
When you have Medicare for all Private corporations will save millions of dollars because they won't be paying for health insurance. Result will be more profit and more taxes to Federal Government. This alone might be enough to cover Medicare for all. Also this is not about numbers this is being done rest of the First World countries in the World and their citizens feel much happier and secure and can retire anytime they feel.
2
@Ali under Warren’s plan employers pay the same amount, just now to the government, so no savings there
As much as I would want to see a complete overhaul of our healthcare system, which I believe is completely broken, I say,
Good luck to Elizabeth Warren with her pie in the sky healthcare plan. I'm sure she is well aware that she is not going to be solely responsible to put this plan into action. She will have to fight the AMA, the insurance and pharmaceutical lobbies, etc. May the force be with you, Elizabeth Warren.
@Diane Steiner you forgot Mitch McConnell, where all legislation goes to die.
1
TL;DR
Seriously, Warren’s policies deal with the real issues facing our country with realistic and intelligently considered proposals. Very little of this can be stated in language simple enough for a short attention span voter. I.e., nearly all voters. She’ll have to present her platform in simplified language and avoid subtle nuance if she wants to win. And there probably isn’t a way to do that (yet) for her single-payer health insurance proposal.
4
I work for a hospital in the insurance billing department and before that I spent 18 years with a private billing company so I am very familiar with the health insurance industry. If Warren is elected and this plans goes thru there are millions of us that will become unemployed.
You can't destroy the health insurance industry without gutting the economy. And I'm not talking about just the major insurance carriers. there are thousands of little insurance companies with people working for them that will be unemployed in the blink of an eye.
Does Ms Warren have a serious clue about where we are going to work after her little plan destroys our jobs.
23
@Rachel
The same thing was said when Obamacare passed, and yet hospitals benefited from increased revenue. Why is that?
What you’re not including in your calculations is the fact that, as it stands right now, a lot of the bills from healthcare providers are never actually paid. Particularly the catastrophic bills frequently coming from unexpected hospitalization.
With universal coverage, the reimbursement may be less, but unpaid bills will virtually disappear. Given that fact, it’s highly possible revenues will increase overall.
5
@Rachel Warren has already said her plan will cause 2 million people to lose their jobs.
This is an election catastrophe.
If we want a system that looks like what they have in Europe, look to Biden, Buttigieg, and Klobuchar. Warren and Sanders would create the world's largest and most expensive system.
9
@Rachel
I am sorry this may affect you negatively.
But you actually make Warren's point stronger: There are unnecessary roadblocks in the current system that can (and should!) be eliminated in the new one.
Maybe you can put your financial skills to work at the expanded IRS? It may be more satisfying to catch tax crooks (like tRump) than being part of an archaic system designed to route sick people's money to the insurance industry.
10
Elizabeth Warren should crowdsource her plan. We live in an era where nobody has a monopoly on the right answer. She should crowdsource insights, use the best insights and rewrite her plan. She can then, very rightly, claim that it is of the people
4
Not exactly a ringing endorsement of Warrens plan by Speaker Pelosi.
Maybe it’s time for the long overdue intra-party debate between the Corporatist establishment and the Socialists?
3
@TR88 Sorry, the supposed "corporatist" center of the party--you know, the people who vote and do all the work and are elected officials--are too busy trying to win the next election even as we tear down the Trump presidency.
To call Pelosi or any Democrat corporatist with all that we have done is a lie.
@OrchardWriting you’re arguing over Semantics. Call them what you will, but you will admit there is a split between the factions that was unresolved in 2016 between Hillary and her Money Machine and let’s call them the Sanders supporters?
My entire block, family, and co-workers are with her 100% and that's in Florida.
5
@Becca Helen How sad. No one thinks for himself.
1
We only need one simple rule on health care: voters get what congress gets. Problem solved.
20
Why does a “scientist,” need to be told that it’s best to look stuff up before sounding off about it?
1
6% annually on wealth means they pay 100% of the value in 17 years. How does that work in year 18?
At 1% per year for property tax in California at least it takes 100 years to pay the value of the house. But to pauvre that in 15 years? This is nuts.
3
@Mary E
You are assuming your wealth is kept under the mattress. If your annual return is 6% or better, you can keep paying 6% per year forever. Even if you assume you are paying a 40% income tax on your return, your wealth is stable if you earn a 10% annual return. And the tax applies only to your wealth above $1 billion, so even if your wealth above $1 billion is slowly shrinking, you still have a billion dollars. You won't have to eat at the soup kitchen.
5
@617to416 I am not worried about the billionaires eating at the soup kitchen, I am worried about the cash flow. You assume the 6% or 10% earnings is cashed out. Is it really or is it in market value?
My house appreciates about 10% per year in California. She would tax capital gains for high earners and 6% of their wealth.
Some may well have 6% return...on paper as stocks go up. But they have to sell to pay the taxes. Will that affect the stock market value of assets? Slightly more complicated than you assume. At 1 or 2% per year, I like her plan. At 6% I question its viability.
@617to416 I am not worried about the billionaires eating at the soup kitchen, I am worried about the cash flow. You assume the 6% or 10% earnings is cashed out. Is it really or is it in market value?
My house appreciates about 10% per year in California. She would tax unrealized capital gains for high earners and 6% of their wealth.
Some may well have 6% return...on paper as stocks go up. But they have to sell to pay the taxes. Will that affect the stock market value of assets? Slightly more complicated than you assume. At 1 or 2% per year, I like her plan. At 6% I question its viability.
My question is, if Warren is elected and was lucky enough to pass Medicare for All, what would happen if Republicans were elected the next time, could they cancel Medicare for All and leave Americans with no health care like the case they have going through the courts now to demolish Obamacare?
12
a universal coverage plan will require the middle class and poor to pay more taxes. Also it would have to deny coverage to all freeriders and non legal residence.
6
Every person will need health care over their lives. No corporation will remain in business forever, and could move away from the country to evade the authority to tax them. Any wealthy individuals could become poor without expecting it, as well as to leave the country. Funding from sources that will change with certainty to support needs that will never end is the model that needs to be evaluated. Warren’s solution is a temporary one that cannot address a sustainably. Eventually those who benefit will have to support the health care system.
4
For all of those against Medicare for All, all the other first world countries do it, why can't we.
We are the richest industrial country on the planet GDP / capita.
And we have parts of the US with infant mortality rates of a second world country.
For all of those against Medicare for All, you come up with a solution to give us universal coverage.
In addition, we spend twice as much per capita and twice as much percent GDP for healthcare as the other countries.
So while you are at it, if you can get lower our cost, that is welcome, too.
Instead, all we get are excuses.
8
Change is not as simple as an hypothetical argument. Single payer, universal systems serve a whole countries with highly predicable risks and demands. Medicare serves elderly people with risks and demands well known but in a health care system that is twice as costly as any other developed country. Medicare is not designed for everyone in this country and it is not going to absorb them all successfully. It will not change the costs of health care by itself.
3
@Independent This isn't what Europe does. They have a mix of private and public, make very tough choices on care and what is and is not covered, and expect people to pay out of pocket as well as with taxes.
If you want to see what Europe does, look at Biden, Butigieg, and Klobuchar's plans. These are the right mix that will win the election and are what the rest of the world is doing.
5
@Independent
No, only a few universal healthcare countries have a single payer system. France, Germany, the Netherlands and almost all other European countries, Japan, Australia Have a multi-payer systems, and also very much utilize private insurers. Yes, Canada and Great Britain have single payer systems, but that’s about it. A true single payer system is still pretty rare.
2
There are two well thought out points in her plan that I would like to highlight;
1. The insistence on cutting drug spend, with focus on brand name high expense drugs. Domino effect on lowering costs all the way around.
2. Disincentivizing hospital ownership of doctors. Hospitals employing high dollar surgical specialists may currently have a bit of a quid pro quo understanding that is not based on medical necessity with regards to their owned doctors "choices.".
It is critical that hospital systems have zero advantage in employing doctors directly or owning doctor practices.
Placing annual costs on unsold stocks is a bad idea though. A tough non-sensical sell.
Thank you
4
The key innovation in this tax proposal is one I’ve been advocating for months and have been frustrated never to see in the debate stage or in the pages of thus newspaper: corporate taxes in lieu of private insurance premiums.
By letting corporations continue to foot most of the bill, Warren avoids a steep payroll tax or VAT, those bugaboos of the right.
5
I don’t hear a lot of talk about why doctors and hospitals get so much more in the US than other countries.
While it may not be obvious, it is not in the interest of private insurance to reduce hospital and doctor costs.
Insurance companies are going to charge by their costs and try for a 5% to 10% profit.
The higher the costs, the more they charge for premiums and the higher the same percent of profits will be.
And doctors and hospitals benefit by getting more than any other country.
Why can’t hospitals and doctors earn less?
Doctors will still make enough for BMWs and a vacation home.
3
@Independent
Reducing compensation to physicians is a short-sighted idea. Even with what you deem to be high salaries, there is already a shortage of physicians in many specialties in the US and a critical one in family practice. It can take weeks in some places to get an appointment with a general practitioner, and weeks or even months to get an appointment with some specialty physicians in many areas.
Her plan (and your suggestion) would lower physician compensation just as demand for their services dramatically increases with the tens of millions of people who didn't have health coverage suddenly having it.
If anything, compensation will need to be increased to address the current shortages and prevent them from significantly worsening in the face of reduced compensation! Either that, or get ready for months-long waits to see any sort of provider. Waits approaching a year? More? It's possible.
8
@Independent
Reducing compensation to physicians is a short-sighted idea. Even with what you deem to be high salaries, there is already a shortage of physicians in many specialties in the US and a critical one in family practice. It can take weeks in some places to get an appointment with a general practitioner, and weeks or even months to get an appointment with some specialty physicians in many areas.
Her plan (and your suggestion) would lower physician compensation just as demand for their services dramatically increases with the tens of millions of people who didn't have health coverage suddenly having it.
If anything, compensation will need to be increased to address the current shortages and prevent them from significantly worsening in the face of reduced compensation! Either that, or get ready for months-long waits to see any sort of provider. Waits approaching a year? More? It's possible.
4
@Jim
I agree about a shortage of physicians.
Come up with a plan to fix it.
I'm for it.
Sure, if you assume reality is suspended, it all works out.
You do know that any government service is controlled by whoever is currently in power, and that changes every 2/4/6 years. Government monopolies are worse than corporate ones, and the only corporate monopolies we've ever actually had were created by government laws, those created by the political class that some hope now will be their friend.
5
Unworkable.
I like the Mayor Pete "Medicare for all who want it" plan.
As a Union worker, with decent health care, I don't want to lose what I have. I also do want everyone else to get what they need to have decent healthcare. Therefore, the "Medicare for all who want it" plan.
Take a look at Mayor Pete. He's got some smart, realistic, compassionate and far reaching changes in mind for health care. And for infrastructure, and climate change, and immigration, and race relations, and foreign policy, and social policy.
President Pete; why not?
19
@thetruthfirst you don’t want it but you want those already on Medicare to throw in with those on the government plan.
I don’t want that.
1
@thetruthfirst, just recognize that it costs more in total than medicare for all.
1
@thetruthfirst
While I like Mayor Pete, the "Medicare for All Who Want It Approach" is a tiny incremental improvement to a system that will remain a bad one. The public option is merely another insurance plan that you still need to buy into by paying a premium and, at least as proposed, will continue to require copayments that many Americans can't afford. It won't result in universal coverage and will do little to make healthcare more affordable. Worse, it preserves and maybe even increases the complexity of our system with its irrational hodgepodge of employer coverage, private coverage, exchange plans, Medicare, Medicaid, VA plans, other government plans, and now a new public insurance plan. You need a Ph.D. in insurance to navigate the system. Enrolling is hard, approvals are hard, filing claims and billing is hard. It's a nightmare.
Here in Ontario, I get my health card (it's renewed every few years) and all I do when I go to the doctor or the hospital is show the card. All the billing is done by the provider and the government. I don't pay a cent or do anything more than just show the card. It's simple. Americans suffer from some kind of Stockholm syndrome where they can't imagine it's impossible to escape their abusers! Please, Americans, get out of your bunkers. There's a whole world outside the US that actually does these things more effectively than you do!
3
Quite amazing that the author blithely refers to non realized gains as "increases in investment value" that will be taxed yearly, instead of "waiting till they are sold." That assumes that every investment makes money and increases in value, a total untruth, and further that investment will continue to thrive in a climate where you are punished for taking chances.
Taxes on unrealized gains are simply a ghastly idea.
23
I respect and admire Sen. Warren. But I think this plan — and several other items on the Democratic Party wish list — guarantees four more years of a Trump (or Pence) administration.
10
In all other Western countries universal healthcare is possible because the gross profits are taken out of the equation.
If you take away the collective costs of insurance premiums, deductibles which can be in the 1000's and copays, people will still be way ahead even with a slight increase in income tax. No medical debts and no worrying if an insurance will turn your claim down
Peace of mind........priceless.
3
@thezaz no just high taxes,rationing and waiting list.
Waiting lists uk are 6 month to see
a cancer specialist just get diagnosis; let alone treatment.
2
@plainleaf that is simply not true
1
Without swift and robust action on climate change we won't be able to afford health care for all no matter what the mechanism.
3
@Scientist ha, she needs to get her priorities in order if you believe as she does.
Why does she care about healthcare at all when we have 12 years to save mankind from doom?
To me that makes Senator Warren soft on Climate Justice.
Warren just lost the nomination. It's not just about the numbers and assumptions however optimistic they may be. It's the lack of judgment and realism exhibited by Warren in thinking that this will appeal to enough voters to win the election.
This country can't afford 4 more years of Trump, period. At least Binden and Buttigieg get that.
5
@Casual_Observer Amen.
The left thinks this is a debate over policy and keep repeating, "But the rest of the world..." It's a debate about direction and winning the general election.
Warren and Sanders will be a disaster if either gets the nomination. They are the best news for Trump and Republicans in a long time.
1
@OrchardWriting Your logic is compelling. You want people to vote for 4 more years of giving the rich more taxbreaks, instead of voting for better and cheaper healthcare for all?
1
Likely her plan will cover reproductive health for all. The problem is that this fear cause more anti-abortion voters to turn out in swing states, which may make the analysis in this article moot.
1
Without swift and robust action on climate change we won't be able to afford health care for all no matter what the mechanism.
1
I think it's time for universal coverage. We have the benefits of having many examples of successful programs. The current system is ridiculous. It's full of holes and gotchas. I am reasonably healthy, and I am savvy enough to make sure everything I need is covered, but it's exhausting. The stress of having to call and make sure that when I go to a routine exam, the practice I am about to visit is still in my network is more that we should be dealing with. What about tests that come with hidden charges? What about tests that nobody can tell you when you agree to pay how much it is going to cost? I have experienced it a few years ago when a pulled a muscle in my back while gardening. If I wanted that diagnostic X-ray, I had to sign that I will pay, but nobody would tell me how much. What about a person who needs a life-saving treatment and is so sick that she cannot give consent regarding who treats her. The hospital calls for the specialist; he saves her life, but she is stuck with thousands of dollars' worth of bills because he is not in-network even though he is the only one in town with the needed skills. This madness should stop, or the simple stress will kill us. Also, a simpler system should lower the cost to providers since they would no longer need an army of clerical staff to help them negotiate all this stuff.
7
As a service to commenters on this thread, here is a chart showing taxes collected as a percentage of US GDP. Note the rapid run up to WW II, then the remarkable consistency since then.
https://fred.stlouisfed.org/series/FYFRGDA188S
2
@Kurfco so we’re paying roughly the same Percentage of GDP as we did during the most catastrophic emergency in World History.
@TR88
Why, yes. That's because Medicare, Medicaid, WIC, SNAP, SSI, Welfare, etc. all came in after that. It's almost as though the US taxpayer was conditioned by the war to pay more in taxes, so the politicians came up with new ways to spend money instead of letting taxes fall back to pre-war levels.
1
Since she will be crucified for raising taxes, thr key to “selling” her plan to people will be to carefully explain, net-net, how much more per year the whole thing will cost them.
She will need to belabor the point that, for the lion’s share of the money ($14.9B), she is simply taking money out of the right pocket instead of the left.
1
Whether it's the fault of the NY Times or of Sen. Warren, I don't know. But this report makes no sense.
Is Sen. Warren advocating an increase in U.S. spending on medical care and medical insurance by $52 trillion in the next ten years? No? If not, then what is the projected business-as-usual spending, and what does Sen. Warren project as spending under her plan?
Reporting must/must lead with net changes for readers to have a chance to make sense of this.
2
Gosh but I am tired of the "we can't do things because I'm a curmudgeon" crowd.
Yeah, this is expensive. We probably won't implement it. Maybe we can get close. We can definitely do better than the status quo. There's a reason the rest of the first world has good health care for their citizens at a drastically lower cost.
Hint: it isn't cranky do-nothings hiding greed behind a curtain of tortured rationalizations and anti-"socialist" rhetoric.
You're either part of the solution or part of the problem. If your first instinct is to shoot down positive social efforts/energy with a bunch of "don't even bother trying"... you're part of the problem.
5
@Dan It’s really not either/or, as in, either you support MFA or you’re a carbuncle on the rear of society. There are multiple ways to get to universal coverage. There are only two examples of true single payer in the developed world - Canada and UK. Why tilt at the MFA windmill when we could be discussing other options that have a much better chance of succeeding?
1
@Lindah And we already are having this discussion, thanks to Elizabeth Warren. The primaries have just begun. This is the time to discuss big ideas.
1
@Lindah that's fine, that's great. Much better than "we just can't do it".
Good luck taxing state governments - especially under this Supreme Court. Its a complete non-starter. As a law professor she should really know better.
4
This fiscal math is a train wreck for the Democratic party.
Warren has become a mad social scientist. forltunately, this nonsense will never clear Congress.
I'm contributing to Democrats in the center, but if Warren gets the nomination, my contributions will go the GOP senaate campaigns, so that there is a clear block to Warren's craziness.
It's sad, because I'd take almost anybody over Trump. Except her , Sanders and Harris. Thre are still a dozen dems in the race of which half are closer to sanity but only probably 2-3 who can make it past Iowa..
7
Nonsense.
Mathematics is a science that provides predictable and repeatable results.
Arithmetic is not.
Because there are too many variables and unknowns to craft the double-blind experimental controlled and/or randomized tests. That is also true of banking, economics, finance, history, law and politics.
Because Elizabeth Warren's ' arithmetic' aka ' figuring' can't be double-blind controlled experimental tested nor randomized it is mostly shadow and smoke and moonbeams.
6
Looking forward to the NYT numbers breakdown on the rest of the candidates’ platform proposals. And Trump’s. Does he have a platform yet?
1
@James Me too, because Trump and Warren will both come out on about the same end. His is a lie and her's is a fantasy wrapped in a lie.
A tax on unrealized gains will end innovation and investment. The vast majority of work in drug development does not involve NIH, so those funds will not lead to medical advances. Physicians likely will not want to become slaves and work at the pleasure of the government for low wages. And note, as this is pure Democratic fodder for their base, there is not a mention of malpractice reform. No question congressman will get top medical care but for everyone else it’s the new third world.
5
There's a huge amount of waste at every level of the US healthcare system. To give just one example: my pharmacist friend says, "Pushing pills is easy. I spend most of my time deciphering the 200 types of insurance plans I have to deal with".
1
What about the benefits ?
The point of Medicare today is to provide healthcare to patients at a reasonable cost that the nation funds - and nobody is looking to abolish it because people know the benefits
These articles are looking to trick people into forgetting about the benefits side of the equation
I wonder how many people are falling for this ruse
6
As we should all know by now, "nothing is free". Universal coverage would be great, but to say that the middle class won't see higher costs is probably not true. Just like in NYC where income taxes have not risen in years, other costs (real estate taxes, utility bills) have gone sky high. Improvements to Obama Care seem the better way to go.
4
@Louis
We are the richest industrial country on the planet GDP / capita.
If the other first world countries can do it, why can't we?
2
@Independent
We are number 10.
see:
https://en.wikipedia.org/wiki/List_of_countries_by_GDP_%28PPP%29_per_capita
We spend $3.5 Trillion a year on healthcare.
That is about $11,000 per person and 17% of GDP.
And it is about twice as much as the rest of the first world countries both per capita and % GDP.
Why don't we have universal health care?
We are already spending the money. The money is there.
The money we are spending with for-profit insurance would go to Medicare for All.
And we would save money by eliminating profits.
And we would eliminate the hassles having to argue with insurance companies why they won’t cover something because they are motivated by profit.
And doctors and hospitals wouldn’t need an army of medical coders trying to figure out what each insurance policy does and doesn’t cover.
Instead, we have parts of the US with infant mortality rates of a second world country.
And we are the richest industrial country on the planet GDP / capita.
25
@Independent
And worker productivity would increase because we would not have to spend a substantial part of every November on trying to figure out next year's health plan.
And employer productivity would increase because they would not have to provide seminar after seminar on how to choose your health care plan.
Or on how to actually get reimbursed for health care cost.
And homelessness would decrease.
And more accessible preventive care would decrease urgent and emergency care.
And increase infant survival rates.
And....
9
@Scientist
Thanks.
Another is that personal bankruptcies from healthcare costs would go away.
But the insurance industry and their bought Republican politicians will fight this with scary and less than truthful media campaigns.
4
@Independent We will not be the richest industrial country on the planet with this plan.
2
Senator Warren's estimates of the savings potential in eliminating private insurers are correct. Possibly even under-estimated. No country requires physicians and other providers of medical care to perform the huge administrative and data-mining functions demanded by US commercial insurers. Staffing, IT, etc. Huge excelerator of physician burn-out. Little gain for quality care, tremendous expenditure of effort to prop up over-compensated insurance executives, create risk data applicable to other insurance products at provider expense.
9
This article leaves out one very important cost “savings” in the Warren plan — that all doctors would be reimbursed at Medicare rates, with specialists being paid slightly lower than said rates, and generalists being paid slightly higher than said rates. In my area of the Northeast, this would mean collections would drop approximately by half overnight.
If this happens, prepare yourselves for a mass exodus of the best and brightest from the medical profession, to be replaced by an army of foreign medical graduates. Some of these FMGs will meet the high standard of medical and surgical care to which Americans are currently accustomed, while many others ... will not. I’ve spent my entire adult life preparing for a highly specialized medical career and I, for one, would go find something better to do.
19
@Dave MD, as someone who is a specialist, I don't think your statement is necessarily true. Canada doesn't have a "mass exodus" of physicians and it is not taken over by FMGs (which, btw, are already at a major disadvantage when it comes to acceptance into residency programs. Their scores need to be much higher than an american grad for the same program). It just means more medical students will go into primary care, which is better overall for the US health system anyways. Family medicine shouldn't be the easiest residency to get into; their scope of practice is so wide and needs smarter medical students going into it. We have a major shortage of primary care physicians and too many specialists (most of which serve urban areas and are scarcely available anywhere else), resulting in many patients seeing more doctors than they need to, in order to get a problem addressed that a PCP can easily handle in other western countries.
10
And all that preparation and specialization sets you up for what promising new career?
Lots of us face economic setbacks, sometimes due to government policy. Talk to the steelworkers in Pittsburgh, if you can find them.
But you situation isn’t so dire as you suppose. That $84,000 a year you’re spending on administrative support? That the national average, per doctor. Gone, poof. You can keep the change.
4
I don’t necessarily disagree with your conclusions if such a system had grown organically here in the United States (and perhaps there are states where docs are already being reimbursed at close to Medicare rates... I believe MD is one of those), but this plan proposes this change over some (undefined) short period of time.
Say what you will about the Boston Medical - Industrial Complex (there are others in the US but this is the one I know), but it is one of the most innovative biomedical research cities in the world, driven forward by highly trained and specialized clinician- and surgeon-scientists. They are already paid at lower academic salaries and will therefore be least tolerant of such a pay cut. They also have the skills and intellectual wherewithal to leave the system. For those of you looking at the Canadian system favorably, ask yourself if more biomedical innovation comes from Canada or the US.
1
Why should we tolerate the unique need for health insurance? Why doesn't the free market set health care cost appropriately to reflect average income? I don't need home insurance to buy a home and I don't need car insurance to buy a car. They aren't easy to afford, but it is certainly possible.
2
You need health insurance for the same reason you need a mortgage to buy a house. It spreads the cost out over a large population the way a mortgage spreads the cost of a house over a number of years. Yes, you could pay for your own healthcare without health insurance, but why take the risk?
We seem to struggle with the fact that health insurance is not health care. Health insurance is a financial instrument that spreads risk. Eliminating it, while it may sound fun, will not change the underlying economics of the current cost structure, it will just eliminate an entire US industry. By the way, insurance companies don’t set provider rates, the AMA does.
Why does the AMA limit the number of medical students and medical schools at such a low number? To preserve the integrity of the academic rigor? Come
on... More like, to preserve their status and wealth by controlling the supply side of the equation (see Dave from Boston’s comment above).
Want to shake things up? Have the government provide actual free care, not take over a private industry. If you want to be a fat cat orthopedic surgeon making $800,000 a year, you owe x number of hours a year for pro bono care in a free clinic. Retired physicians can work for a small govt salary part-time for tax advantages. Nurse practitioners can have more prominent roles... no insurance, no problem. BUT, you don’t get to have a normal delivery in John Hopkins’ emergency room.
1
@Brad Well of course, but the risk to which you're referring is the 'debilitating cost' as it stands now.
Yes, catastrophic illness may still be a problem, but health costs would be much less in just insuring against that.
To continue. As for how she plans to pay for this, I'm not so sure it would be good for the average person. I am not rich but nor am I poor. I think I will get hit hard by hidden taxes. I know I will get an argument on this, but while I do think that corporations should be taxed more than they are currently taxed, corporations will have to get that money back from someplace at that place is the consumer. That means we get a regressive tax scheme where the consumers are indirectly paying the tax increases of the corporations. Also, her plan to ramp up the IRS is excellent and long over due. But that takes time and a lot of money. It will be years before newly hired Agents are trained able to do the job she expects them to do. Maybe her whole first term. She cannot rely on that for immediate results.
1
Medicare for none. Coverage for all. Canada et al cap provider payments whether for materials, drugs or permitted services. In general, we don’t. That’s why our socialized program for seniors, Medicare, spends more of our GDP than other developed countries do to cover all of their people. That’s the elephant in the room - to get what others have you have to start with Medicare for none. She has elements of this with her payment controls. Unfortunately the politics of managing elder care to cover everyone else is near impossible.
1
Your graph is a bit misleading. While the employer and government payments shown in green (new revenue) are being paid into the new plan, they are currently being paid into existing private or state plans. So rather than new money, they represent redirected money. The other "new revenues" do come from different payers. But those revenues replace money now paid in premiums, deductibles, copays, and coinsurance by covered individuals. Essentially what Warren does is transfer the costs individuals now pay to corporations and the wealthy, while leaving employers and governments with similar costs as they have now.
1
It would seem to me that the sensible thing for these candidates to do is to assess what health care costs might be with the profit going to corporations currently removed and then compare them to the money that most people are currently paying for their health insurance, including deductibles and copays. In most modern countries with single payer or other government health care, the costs to the citizens is much less than ours and the outcomes are better.
For instance, right now, on Medicare, I pay twice as much for my supplement, which covers 20% of the costs, than for my Plan B, which covers the remaining 80%, By rights, this "tax" would increase what I am paying to the government by an additional 25% instead.
2
I wish that Elizabeth Warren and Bernie Sanders would keep pointing to our neighbors in the North: Canada. Canadians have universal health insurance by law, yet have the same or better life expectancy and overall health we have, and all at a cost of a little over half per person of what we are paying stateside. Maybe the lower drug prices and the absence of multi-million dollar bonuses for insurance and hospital CEOs has something to do with this?
16
Elizabeth Warren's Medicare for All is very ambitious. Quite frankly it is too ambitious. People who love their private healthcare plans will not go along with a plan that is risky and untried. I do not know how this plan can be cost effective when we do not really know the actual cost. This sounds great on paper but when something sounds too good to be true it usually is. And this is too good to be true. Ms. Warren is dreaming if she thinks this will work. It will not.
7
I'm not thinking big (Nationally), I'm thinking small (me). Call me selfish. I am concerned about what my coverage will be. Right now I have a pretty good plan and my out-of-pocket expenses are still high and go up every year, but they are still affordable. What will my coverage be with a Government plan. Will I still be able to choose my doctors without a referral? Will some Doctors not participate in the plan, and will they be my doctors (Specialists who have been treating me for about 12 years)? No one is talking about this. Now, it is hard enough dealing with the bureaucracy of my insurance company (BCBS), but not really terrible, at least they try. How will it be to deal with a Government bureaucracy that is handling nearly every person in the country. Whew! Do I pay and get reimbursed (how long will that take) or do I just get billed for my share of the bill? There are a lot more question that concern the individual that have not been addressed.
8
@PeterJ
Obviously you are not on medicare. Yes, some carriage trade specialists dont accept medicare, but the real problem is primary care . To make this work-even now pre warren plan- reimbursement for primary must go up and procures need to be compensated less. Thsi imbalanc did will doubtlessly improve with federal influence extending over larger percentage fo health care encounters/fees. Medicare coverage is fine, even in hospital. Your drug plan may well be mope $$ under current Medicare, but warren intends to reduce that by allowing medicare to bargain pricier for volume -it will work, perhaps not to extent she hopes, but it will result in significant savings. Administratively for MOST my peers who have transitioned to medicare, parts A and B see less compared to private insurance, drug plans under part D a wash compared to employees supplied plan. As for Balance billing , medicare eschews that and providers have to alert you very explicitly hat they may balance bills but even then its capped. Way fewer surprise bills in medicare coverage for most patients. Fewer period cures will be done (most unnecessary)fewere proceduralists available (longer-waits forelective procedures) and fewer applicants to medical school (sl decline in intellectual ability fo doctors but per-has more commitment so a wash IMO) the problems with medicare for all are second order effects -
2
@PeterJ - She definitely needs to explain that. But from how other universal care systems work, it will look something like this: All doctors will participate, as there is no other way for them to stay in business. You may choose any doctor nation-wide, as there is only a single "network" in the country. You'll just hand over your card and not get any bills anymore. That's how it works in Germany.
3
@John Wesley No John, I am not on Medicare. I am 67 years old and still working. I don't know what Medicare costs but I hear people complain. I still pay for a family plan and will for almost 2 years. I had major surgery 12 years ago that requires significant medical visits to ensure there is no rejection and to maintain everything else. So medical insurance costs and coverage is important to me and my primary care costs close to zero.
So will there be two payroll taxes. One for my present Medicare coverage, and my Medicare tax for the future? Will retiree’s continue as they have or will we continue to pay for them?
She is correct. You can arrive at the same basic result by understanding the effects of the elimination of [some of] the private insurers' wealth accumulation and the streamlining due to far better organization and simpler billing infrastructure and more participation capita.
It really is a no-brainer, and that is why everyone in the world embraces more uniform, national health plans (except us).
No one has anything to lose in the transformation (except their chains).
5
No, I don't think it will happen. Krugman and I agree! Relax. However Warren deserves credit for her determination and advocacy. Maybe she'll make modifications which are needed and will make it more palatable. Do all those folks who write here in opposition prefer the status quo?
2
Based on an admittedly tiny sample, something I have long predicted now appears to be happening: a protracted stock market climb combined with insurance company hassles and the looming medical care environment, is driving 50 and 60 year old doctors to retire.
It will come as a rude shock to Warren and Sanders but doctors will not become indentured servants. As long as this continues to be a free country, they will retire rather than work for wages that will make Warren's numbers work. Democrats always seem to think they can proceed on the basis of "floggings will continue until morale improves".
34
@Kurfco
As a practicing physician , your observation is correct re CURRENT doctors. Future Physicians will not be able financially to retire early, and quality of medical students will decline , but we will still have plenty of applicants. They will accept lower wages but will work less hard. But we are already seeing these changes. Warren and Saunders biggest challenge is the tempo they propose. 4 years is not long enough to pull this off when you are talking about almost 1/3 of the economy. We will need more Time time to adjust to make sure hospital closures are not distributed randomly leaving huge geographic gaps, we evolve organically to fewer proceduralists and more primary care docs, and we find jobs for the many hundreds of thousands of insurance company employees, billing agents in drs offices, and administrators who will be looking for work . Biden/buttigieg much closer to the mark with the evolutionary plans esp re cadence. i am not concerned that tax breaks for cosmetic surgery, drug company avarice, Wall Street And healthcare for profit will decline markedly.
6
@Kurfco - Doctors will still earn a lot. In major cities of Germany, we have literally more than twice as many doctors than traffic lights! They are all doing fine.
5
@John Wesley -- Based on the skill level I perceive in your comments, I nominate you to be one of the Doctor representatives on Warren's Health Care Reform advisory commission. Somebody who works in the trenches of the business and knows what is really needed at the doctor level to make the changes manageable and efficacious. When people like you open your mouth and start talking, I start feeling hopeful and confident that if we all band together, we can make the needed changes work for everyone. It won't be perfect, but it will be better to have the for-profit element out of health care.
The current system is crazy. How crazy? Here's how crazy -- I was in a hospital and was told I might need a certain procedure done. I was in the office that does the procedure at a counter with workers and their computers. I asked the simple question: "Suppose I paid cash for the procedure, what would it cost?" After a half-hour of phone calls to God-knows who, they finally gave me the official answer "We don't know." That's how dysfunctional the current system is on the patient facing side of things. My primary care physician has 2,000 patients a year. That is simply crazy.
1
We already spend a far greater proportion of our national spending compared with other developed nations for healthcare. A recent JAMA article stated that we waste $800 billion (out of $3.7 billion) in healthcare costs. Some say the amount wasted is far greater than that.
A plan that would be popular and that can achieve many of the issues of access is to follow policy that countries that offer universal care such as Canada, UK, and France and to raise the approx $1 Federal tobacco tax to about $5 to $6 per pack that these countries charge.
While tobacco use is declining, the rate for those at the poverty level and below has remained constant at about one-third for over 25 years.
Raising tobacco taxes has the greatest impact on getting people to quit or to never start. A reason for the high cost of premiums and other medical expenses for non-smokers is this subsidy of smokers healthcare.
There are 13 billion packs smoked yearly so raising those tobacco taxes to about $6 per pack would yield tens of billions of dollars each year without costing non-smokers any money at all.
These funds then could be used to fund additional community health centers and to better fund public hospitals.
This is win-win. Non-smokers reduce the amount of money they pay for healthcare costs of smokers and there is no tax increase for non-smokers. Many smokers will quit smoking and many will not start. There is a great deal of improved access to care for the poor.
6
@David MD
It’s pretty to think so but consider second order effects-at some point it becomes useful to sell and buy bootleg tobacco and a $6 or pack tax seems more than enough to drive that dynamic. Plus European taxes are way higher than in usa, e.g. a 20% NATIONAL VAT(sales) tax. There si no free lunch as well-one. One policy wonks adminitrative savings is another persons job , not just another operate fat cat salary. Obviously this should hold up moving forward, but putting hundreds of Thousands of billers, coders and collector on the streets couple asily tip economy into recession vitiating any “savings” contemplated.
@John Wesley
The point of the healthcare system is to have healthier people, not to treat people acutely for illnesses that could have been prevented, including those of tobacco use.
The minimum cost for cigarettes in NYC is $13 and the minimum age of purchase. While there is some bootlegging there are far greater tax revenues from the increase taxes.
Raising taxes is part of the six point MPOWER program which is promoted in low-income countries (e.g. China, India) by Mike Bloomberg and Bill Gates who collectively have donated about $1.2 billion to the efforts.
The last thing we want to do is to employ people to treat preventable illnesses.
The nation does not need to spend an even greater proportion of our GDP for health, rather we need to address the reasons for the amount of care costs which has to do with preventable behaviors such as smoking.
I think the government should create a no frills basic package Medicare for all. While allowing insurance companies to offer their own packages. If the governments option is of a decent quality insurance companies will have to be more competitive. It seems health insurers are price fixing at this point.
6
Inefficiencies in our current system include: Tri-Care, Federal Employee Health Benefits Plans, Veterans Affairs and our entire approach to Mental Health, Dental Care and Pharmacy. If even some of these gross inefficiencies can be rectified, the plan will be worth it.
We are not one nation with equal protection of the laws; we are a polyglot of competing self-interests, each marginalizing others to achieve their own ends.
We have corrupted the meaning of fairness.
Warren's policy is the first step to correcting our national decline. I hope we will take it.
6
I love how everyone is worried about how "Medicare for all" gets paid for like the wealthiest individuals/corporations didn't recently get a huge tax cut and a dozen countries haven't already implemented such a system.
1
There are lobbies in Congress that would likely prevent most of Warren's plan from going through. Raising taxes on individuals would probably pass. The insider thinking seems to be to just get all Americans covered no matter what the cost, and worry about the rest later.
@Mark Browning Worrying about what conservatives think has prevented progress in this country since WWII.
It is past time to steamroll them into submission through mass action. Warren has the courage to do that.
Others lack that courage.
1
What about the OTHER $50 trillion, which Democrats said were necessary in their view to have the US keep the climate from changing?
Where else would those come from?
Maybe the families, rich or poor, who have a disposable $1 million (that is what it comes to) should vote for the Democratic candidate.
While the families who want, modestly, more jobs and, because of more jobs than takers, raises in wages, those should vote for Trump.
2
@novoad
This sort of attitude that the People should accept the crumbs the GOP is willing to give them must be ridiculed and called out. Just because you believe nothing is possible and that the rich deserve to treat everyone one else with contempt doesn’t mean real Americans should accept your poor self image and appeasement. We won’t!
1
""they would pay taxes on increases in investment value annually, instead of waiting until assets are sold"
1. There's no new or extra revenue there. The tax that would be collected when the assets are sold is instead collected piecemeal during the period the assets are held. In the long run the total amount of tax is the same.
2. If there is a decrease in the investment value in a given year then do you get a refund?
3
@G.S. It is not the same. Many investments never gain in value, but taxing them every year pretends that they do, all it does is take money from investors.
Yes, indeed, a great question.....
2
@Ernest Montague
"It is not the same"
If they gain in value, and that is the case I was addressing, then it is the same.
"Many investments never gain in value, but taxing them every year pretends that they do"
I think you may have misinterpreted what would be taxed.
The plan talks only about taxing the increase in value. So ones that never gain in value would not be taxed.
1
@G.S.
If you tax gains on mark to market basis annually, teh taxes are paid way earlier (even decauxdes earlier) at a min that frontlaods the taxes, leaves less money for investor to invest, and since there is presumably no “loss” declared annually as its unrealized loss, its lose lose for the investor.consider if a $10 stock rises and falls 10% say every other year, at the end of ten years there is NO capital appreciation to the owner BUT they have paid taxes on Intermittant unrealized paper “gains” $5-thats ah huge difference from today and effectively erode investor cash by over 50% !! Thsi is a huge Trojan horse or an awfully poorly thought out tax. Better to extend long term fro capital gains to say 5 or 10 years, or even do away with distinction between “long” and :”short” gains.
1
The funny thing of all this financial figuring....how to pay for medicare for all.....is that medicare for all is already in place but people are NOT paying attention. The people without medical insurance go to the emergency room when they need medical care and the emergency rooms are required to give them care. SO, WHO PAYS FOR THAT????? You and I and everyone who ever went to a hospital pays for their service through a process called PADDING. This is a magical financial transaction whereby a small percentage(ok, maybe not so small) is added to everyone's hospital bill to cover for those who can not pay (why do you think one aspirin in a hospital costs 5 or 10 dollars?). No, this idea that we can not afford medicare for all is pure nonsense. We are already paying for medicare for all and nobody realizes it because they can't think beyond step one.
23
@Frederick c Bucheit Untrue. Once there's a single payer, that's where the corruption will take place. That's where central planning will fail to deal with the myriad issues that affect all dynamic enterprises.
Health care will get worse in the US and in other countries that lose the benefits created by free markets, which are already lost due to so much government interference (they already control 50% of the market and prices are higher than ever...but we're told these are not related by the dotard class).
Factional politics will ruin everything.
3
@David "Once there's a single payer, that's where the corruption will take place. That's where central planning will fail to deal with the myriad issues that affect all dynamic enterprises."
Many other countries deal fine with the "myriad issues that affect all dynamic enterprises." Why do you think this will be doomsday in the U.S.? I see no reason to believe transition to Medicare for All will be anything but prodtive.
Just a few observations about Warren's very flimsy math:
1) 2.3 percent overhead?
Does anything in the government operate with 2 percent overhead? Anything? Has she factored in the massive systems that need to be implemented to track and cover this? Remember the disaster of Obamacare? This is tiny compared to this. And thousands of people will need to be hired to oversee all this. And when the costs spiral out of control then panels of politicians and bureacrats will need to be put in place to determine if your 90 year old mother is eligible for that hip replacement.
2) Going after tax cheats
If there was so much money to be found by going after tax cheats don't you think Obama or Bush or Clinton would have gone down that road already? And is she planning to triple or quadruple the size of the IRS to do this?
3) She has not factored in the costs of giving free healthcare to illegal immigrants when she "opens the borders." Millions will be arriving shortly thereafter, showing up in our hospitals and populating our schools with kids who can't speak English.
4) How does she plan to reduce the price of drugs by 70 percent? With her magic wand? Remember the Big Pharma Lobby, funding both Democrats and Republicans? Are they going to just disappear?
5) Wealth Tax
Every European country that has tried to implement this has failed. You will need a massive government bureaucracy to go to every rich person and value every asset they own every year? Really???
14
@Sarah9
1. Medicare administrative costs today are actually less than 2%. Private insurance company administrative costs are pegged at 17 to 20 percent. They were in the 30% range until Obamacare forced greater efficiency.
2. Republicans have consistently underfunded IRS specifically to cut reduce their ability to find tax cheats, most of whom are in the 1% with some in the 10%. These are the masters to whom the Republicans and many Democrats answer. Every knowledgeable economist agrees that substantial tax money could be recaptured if IRS was given the resources it needs, but without Sanders or Warren to push it this won't happen. The only dispute among experts is as to how many hundreds of millions is involved.
3. No one including Warren has everr suggested "open borders"'
4. Big pharma spends far more on advertising and legalized bribes to prescribers than on anything else except possible executive compensation and obscene profits. Once someone not in their pocket forces the issue, the cost cuts are readily available.
5. Wrong 3 countries still do it. Economists agree that the failure in other countries was due to an unwillingness in those countries to provide the resources to enforce it and the effect of 1% lobbying.
6. Try again?
5
@Jack Robinson
1. TRue, but medicare will not get more efficient .sure wont cost 120% in overhead but i think warren being optimistic still at 2.3% .it will be higher ...how much higher ? Still in single digits.so big s in HS but not as much as she proposes
2. Yes Audits can produce much more in taxes, but taxpayers will adjust , accountants will get rich. Again, a big improvement but in the end far less than warren banking on
3. Warren explicitly decriminalizes illegal entry. I suppose we can erect a wall, but without penalties, if anyone is allowed to come and work in the USA, how is this anything other than , in effect open borders ? Anyoen can cross border without approval and not be detained and forcibly returned.
So we will in effect have border for goods and drugs but not people ? Decriminalizing illegal entry effectively opens the borders, stop being fatuous/ 4. Big pharma obviously can cut costs, but Rand D will suffer, nowhere near as much as they profess for dugs that make a difference tho so I’m with you here
5. \we cna enforce any tax with enough supervision scrutiny and policing, but those countries, which culturally accept far more intrusive gievn ent than USA, found their citizens rebelling in behaviors and even violence at confiscatory wealth tax, plus huge migration to tax havens
we risk being ignored by exaggerating and having magical thinking about the costs, unintended consequences of transforming 1/3 of the nations econ in 4 yrs
@Sarah99
Better than poor people dying because they can’t afford insurance. Where is your concern about that? What’s your plan... just to let them die so you can be rich?
2
THANK YOU, SENATOR WARREN, for helping Trump and the GOP win in 2020 with your 50 Trillion (with a "T") dollar program of health care bankruptcy!
30
@Mike
Thank you Senator Warren for your care about all Americans and all of our lives! Thank you for caring enough to try. We will all work to help make this happen, (except for the haters and those who are so empty, cruel and corrupt that they define themselves by the money they have compared to others).
2
@Mike
It's as if you don't know that the US is projected to spend the same $50 trillion on health care under the current system. We are not spending more money, we're just collecting it differently.
4
It’s so refreshing to see all the nits of this plan being debated. Is it perfect? No. But I’d rather be analyzing the pros and cons of a plan like this than pontificating over the latest stupid tweet of our current leader. Don’t forget that, people. An engaged and thoughtful leader is what we are voting for in 2020, not just a perfect plan.
9
@Shanda Boyett Sure, because the best way forward is for politicians to buy votes with freebies, because everyone has the same lives and issues and concerns. Government monopolies are the worst, and the next election after such a plan is put into place will just make it subject to never-ending political manipulations because that's where the money is. Corruption is ensured; greedy and envious taxpayers have their votes purchased.
1
@Shanda Boyett I would rather cringe at dumb tweets and have a great capitalistic economy than turn ourself into Cuba or Venezuela
Warren is popular with lefties only. Most Americans don't want a single payer system. She has doomed her chances of being elected by embracing Medicare for All.
15
@Mark
No. Warren is popular with human beings who have the empathy gene, and those who work, and support America’s values over the greed and corruption of the few. No rational human being would reject Medicare for All.
1
We will hear many lies about Warren. The banks, Wall Street, the health industry and oil and gas industries are terrified of her and will be painting the worst picture of her they can. Lies will spread like wildfire on facebook and the russian trolls will be hammering her.
Truth will have small part in the fight against her so it's up to us to read reality based writing like Krugman's this morning. The other side will have limitless money and trump certainly doesn't mind telling lies. The whole right wing media will be viciously attacking her.
Be ready!!
4
Naysayers galore. Little discussion (at least as far as I got in Comments) about the fact that the current process ain't working. We spend far more money for much worse results than other nations while Big Drugs, Big Hospitals and Big Insurance suck our citizens dry in order to pad their profits.
For cripe's sake, even Botswana (!) has universal health care! Are we to believe that the Best Country on The Planet can't figure out how to do what Cuba, and Thailand, and China, ad nauseum have been doing for ages?
And lots of "Eeeeeks" about TAXES!! Grover Norquist is giggling in his morning beer. American's tax rates are at all-time lows - below all-time lows if your happen to be a Scrooge McDuck or a Big Business.
Taxes are what keeps a country open for business and our touted "low taxes" result in failures in everything from public lands agencies to road maintenance.
12
This would be a disaster. Why do so many people think govt can do a good job running our healthcare? Govt currently provides crappy service on so many levels (VA, child protective agencies, DMV, you name it at all levels). I have worked in govt on and off for over 30 years and I personally know the ineptitude- you want to destroy something, give it to a govt bureaucrat who answers to virtually no one and does not have to compete or actually produce anything. Private healthcare is far from perfect, but no doubt a single payer (govt only) option isn't in no way a good alternative. Look how well Obama
Care has turned out, NOT.
9
@PG
Other countries do it successfully. I have dealt with insurance companies nearly all of my life. They cause far more harm and destroy more lives than a government run healthcare system would. They embody greed and death.
2
@PG Government won't provide the care. It'll make the laws that govern how the care is being paid for. That's all.
2
This is an example of how to lie with numbers. But while the plan can be criticized in many areas, let me just point the obvious one that would have a serious impact on our healthcare, the unintended consequence of over-confident government: DOCTORS. if the pay to doctors will go down to control the costs, the best doctors will form private practices and will only accept cash. So only the rich will have access to the best surgeons, etc. where as the rest of us will have to contend with butchers. in addition we will have doctor shortage —why would a bright individual go through 8 years of rigorous study when she can become an engineer in 4 and make more money.
well good luck with socialism to us all!
9
@Investor123
A bit of exaggeration. Amusing though. Butchers? Really! Be aware that 2 separate systems exist and have for a few years. Once managed care took hold (think Medicare Advantage and many other plans except standard Medicare) many doctors went to cash only or to concierge practices, both with no insurance and more costly. The doctors remaining are not butchers but for various reasons have not changed their source of income.
2
@blgreenie The young doctors "remaining" are not going into primary care because it doesn't pay. Hence, we have an abundance of specialists and shortage elsewhere. No there aren't butchers, more of a scarcity.
3
@Investor123
I know it's hard to believe, but we actually do still have doctors in Canada. Good ones too.
2
Go big or go home.
You go, girl. Of course she will have to negotiate with Congress, vested interests, etc. But if you don't aim high, why run for president? To maintain the status quo?
And after Trump has ended our endless wars, the Pentagon budget should be ripe for trimming.
8
Anyone who cares for Facts , as opposed to assumptions crafted to support pre-set views would benefit from revisiting the fifty plus year old assumptions of the original Medicare Act.
Reading them now is an act of humor with how far off, by understating, they were. No one now really cares as they got Medicare established didn't they?
Don Berwick has his voice but for me if he wants credibility now, before any new Plan' s passage, let him examine those original Plan's assumptions and how they turned out in actuality and publish his findings.
This is not going to happen as Warren's plan is really only meant for those who want to be convinced of its doability -- a fig leaf. She is only putting these numbers out because she feels political pressure to do so. This is political calculation disguised as straight talk, "I have a plan for that.'
We get the politicians we deserve if we do not hold them accountable. What exact price will Berwick and Warren pay if their assumptions are incorrect? We know the answer as do they.
2
Interesting that every time I see drug prices being lowered, it is to use generic drugs. How will drug companies recoup investment? I firmly believe there should be national price gouging controls to keep prices from being predatory, but for the past several decades the US has been a prime ground for paying for the world's medicine. Even European drug makers recoup their money through high US prices to subsidize R&D. That unfairly cost US users too much money, but all drugs can't be generic once the patent is expired, as the price for patented drugs will skyrocket knowing that once protection expires only the low cost makers win. And my experience with generics is spotty at times. Same as the brand, and sometimes much worse.
2
@James
If it was going to R&D that would be one thing. But, in fact, the major drug companies spend far more on advertising and legally bribing doctors than they do on R&D.
2
I have tremendous respect for Senator Warren, but this depends on the same magical thinking - that you can create something from nothing - that dominates economics and produces avoidable, devastating crashes. I hope she does NOT persist on this one!
7
For a change we have a very smart and educated presidential candidate. Her plans are well thought through and detailed - this is her difference from very honest and emotionally charge Bernie Sanders. Status quo and and "sold-to-insures" Obama care will continue ruining our budgets while providing worse and worse services. Annually increases in medical insurance costs and reductions in quality are not sustainable. Warren proposes a system tested and proven to be excellent and much less expensive in other countries. Just discuss quality of medicare-for-all services in Switzerland - it is superb in quality and cost about a half of our mediocre system provides to us. No brainer for smart people, but general electorate will scared by lobbyists and the media from CNN to FOX to MSNBC - they are all super-reach with salaries in $M and are scared that if Warren will be our president they have to pay more in taxes.
5
I used to support the Senator’s vision, but the defense cuts are a deal breaker. Beijing and Moscow must be reveling in joy.
5
There's a lot here that I like, the cost cutting measures seem reasonable and overdue. I like the idea of cutting military spending. But at the end of the day these ideas will be the death of the democrats. The need to stop talking about how they're going to raise taxes and put burdens on businesses. Its a hard truth too that you can't get far with ideas like taxing the wealthy. Democrats instead need to focus on beating trump, and I think they do that by being pragmatic, not matching his extreme... They to focus on fixing whats wrong (campaign finance, among other things, then maybe we can start talking about these ambitious/radically disruptive proposals, and if we need them at all...
4
@joe
Yes! Could not agree more. I wish Warren could read your Comment and let that soak in for a while but the cat is already out of the bag for Warren. The Dems won't win this election unless they are ruthlessly pragmatic, realistic, and understand that much needed change can only happen if Trump is first out of office.
"minimal administrative spending"
I have to see that to believe it.
4
@G.S.
She used the current Medicare administrative rate. It's amazing but Medicare is far more efficient than the private insurance companies.
2
One simply can't ignore the fact that e very other advanced country in the world gets better health care results by every metric than the US does under our greedy cost-increasing private insurance system and does it for half or less than our costs. A true single payer, Medicare for all approach should therefor save even more than Warren's estimates.
All the arguments against here are simply repetitions of the same kool-aid that the 1% insurance companies and big pharma have sold to the gullible public for decades. Are Americans really really more incompetent than the Canadians, the British, the Japanese and the rest? The US is not as incompetent and incapable as the establishment wants you to believe.
5
I dint care what she thinks. Or what some economists who she pays millions think.
I’d like the media to pretend it’s Trumps plan and go over every line with a critical eye.
You know, do your job.
3
"Income earned by immigrants, following the passage of her immigration overhaul plan, would provide new tax revenues. ($400 billion)
Why does that need immigration overhaul? All immigrants are already required to pay taxes. So the $400B is fictitious.
4
@G.S. They do pay payroll taxes-ie SSI.medciare...they dont [ay “income taxes” ie fill out tax forms each year. They also have kids in school for free.
Suggestion for author Sanger-Katz:
Take a page out of the book of T.R. Reid and tour the countries with single-payer health systems like Taiwan, Australia, UK, Denmark, Norway, etc. Get into doctors' offices and understand their overheads. Then and only then are you justified in your skepticism about the forces to lower costs when all of power transfers to the customers, and the administrative costs to the providers drops by 80 percent or more because they have just one payer to deal with. In most of these countries, the providers are paid with what is essentially a zero-fee credit card.
3
Politicians are the absolute worst . All they do is fool voters ( many if not most ) by telling them things they think you want to hear and then go behind closed doors and do whatever big business and big donors tell them to do .
In the case of " Medicare For All " they have taken a program that beneficiaries feel positive about and that works and suggest making changes to it that may harm it , and may be difficult to impossible to do , but most of all are not necessary to make improvements to our health care systems that many people need .
So, first of all we already have in place options that only need to be tweaked , or changed to improve and can leave Medicare alone . Our biggest unmet need is for Long Term Care which can be met by increased funding to Medicaid and subsidies for everyone else for Private LTC Insurance . The ACA was going to do that but designers chickened out at the cost projections and pulled it out .
Subsidies for employees and employers can easily be added to make Private Insurance more affordable for both and Obamacare has already helped and can be improved and other things can be done to hold down health care costs and to improve the quality of care.
Messing with Medicare is just the latest " bomb " floated by politicians who think that's what you want to hear .
3
And when she decriminalizes border crossings, how will Medicare for All pay for the influx of 'immigrants' who get healthcare free?
A million people at the southern border this year alone.
How is that sustainable?
10
@CNNNNC
Easy. Your taxes will rise.
Senator Warren has laid out a plan. Sure, it isn't likely completely achievable in four or five years. But in eight or ten? Probably.
Commenters say her plan will kill the Democratic Party's hopes to win the Presidency this time. But the campaign for President hasn't begun yet. Our candidate hasn't been selected yet. If the candidate is Ms. Warren, then I suspect she will lay out a plan to phase-in Medicare for all, making it more palatable to all those who oppose changing our health system... for the better. She has laid out clearly the benchmarks for healing the system.
.
2
She cannot win the presidency with a plan like this. Too costly (in the minds of the electorate), easily trashed by her opposition, and too disruptive. Plus, the math is questionable.
7
This is a bizarre and impossible plan. It is not only an immoral plan, but it is also impractical. The purpose of good government is to secure rights and not to provide goods and services. Government is an umpire, not a player. Back to the drawing board, Ms. Warren. Your plan is DOA.
6
@Mark A. Hurt, MD - The government is not meant to provide the services. This is a plan for how to layout laws that govern how the services are paid for.
1
The Democrats always shot themselves in the foot at election time. Instead of staying on message- raise the minimum wage, improve the ACA, lower the cost of prescription drugs, provide more funds to community colleges, reform our tax system, restore environmental legislation, the Democrats especially Waren and Sanders propose complicated plans that confuse the voters and allow the GOP to attack them for supporting Big Government and higher taxes. The goal should be to get the lunatic out of the White House.
4
Warren's plan is a massive cost shift to the states. She's passing the buck. Her plan anticipates $6.1 trillion in new revenue from the states, which is going to come in the form of huge new tax increases on regular people, not just millionaires and billionaires. Maybe that's fine as a way to get rid of our hated private insurance system, but she needs to be honest about it and quit trying to trick people into thinking this won't come at a cost to the middle class and the working class.
5
Senator Warren is correct in wanting to extend Medicare fo all. The issues are twofold: political and economic. The latter depends on bringing down the cost of medicine. This can be done and must be done, regardless of the healthcare plan candidates propose. Then, even if a small tax increase has to be passed in exchange for less expensive medical costs and greater coverage, the public will adopt. Like the ACA, it had a rough beginning, but now it’s generally accepted because if it’s tangible benefits. A small tax increase will be accepted in time. The real problem is the political hurdle. Lobbyists and Pharma, insurance cos. and others will fight to the death. But healthcare through Medicare is a great idea.
1
Trump got elected president merely by waving his arms and pronouncing that he would give Americans the Best Medical Care Ever. So why do the challenging candidates feel that they have to spell out every detail of their plans for improving medical care?
1
Because she’s a woman and as such has to be more buttoned up to be considered viable.
2
This would be a vast bonfire of political capital that becomes a sorry mess of ashes blowing around Capitol Hill. Better to spend political capital for something productive: improving the ACA.
Let's help those who are still struggling to pay for healthcare, and leave everyone else's health care alone. And then have some political capital left over for other priorities.
9
the 6% (3+3) tax on billionaires will generate wayyy less $$ than Sen Warren thinks. First, this type of plan has failed all over Europe already - please learn from their mistakes. 2nd, consider sports team owners (almost all billionaires) who will need to come up with 60% over 10 years. When these folks go to sell big chunks of their teams, the team price will decline. We won't feel sorry for them, but we also will then be taxing them off a way lower base. If you believe the wealth tax revenue projections, I've got a bridge to sell you.
4
The pitch I keep waiting to hear is the realistic impact on individual household budgets. For example, I pay approx $600/mo in premiums (including dental) to keep my entire family covered (I have 3 kids). Under a single-payer system, would I be paying about the same per month in taxes? Or more? Or less? I strongly suspect my monthly contribution to this coverage would go down under a Medicare For All scheme, but I'd love to hear Warren (or anyone else) state the impact in those precise terms. Seems to me THAT might be the best sales pitch for most Americans.
1
@jane
Your monthly premiums under Medicare would definitely go down, mostly because Medicare pays providers less than insurance companies do. Which is the real battleground of the Medicare For All proposal, and why the medical industry is so worried about it. Who will be then be paying for the reduced costs of Medicare For All? Mostly doctors, labs and hospitals.
2
I thought the point of single-payer was to get away from employers paying for their employees health insurance? Under Warren's scheme - how does the employer paying taxes part work for freelancers/self-employed folks? What happens with small businesses that currently do not pay any of their employees health insurance premiums?
2
@gmp Under her plan small businesses with under 50 employees won’t have to pay the tax.
2
"Income tax collections would increase, since workers would no longer pay part of their salaries for insurance premiums, which are not taxed now. ($1.4 trillion)"
Way overestimated.
About 90% of taxpayers use the standard deductions, so whatever they pay for insurance premiums is NOT deducted from their taxable income.
5
@G.S. I agree but I think there is another reason to question this estimate:
Her plan has employers paying to the government what they currently pay to insurers. OK, but in that case, why would employees get a raise?
Bernie at least argues (and economists agree, directionally) that since an employees total compensation is wages/salary plus benefits, if the government provides the benefits then wages/salaries ought to rise. That would lead to more taxable income.
But since Warren aims to keep total corporate outlays the same, I don't see the new taxable income.
2
@G.S. I am not as sure as I was ten minutes ago.
From her plan:
"Medicare for All puts a whole lot of money back in the American people’s pockets. One way it does that is by taking the share of premiums employees are responsible for paying through employer-sponsored insurance — that line on pay stubs each week or month that says “health insurance” — and returning it to working people. Congratulations on the raise!"
That raises $1.15 trillion, or $1.4 T here, including other stuff like HSAs, co-pays.
If - *IF* - I follow her accounting it works like this:
Currently, Company pays, eg, $15k per participating employee to insurer;
Participating employees give up $5k from their paycheck.
Under her plan:
Company "cost" redirected to government is $10k.
Employees get a $5k raise, subject to normal taxes.
Definitely maybe. I'm leaning her way on this.
(Future gamesmanship: if this plan looks like it might become law, companies will consider giving everyone a raise AND increasing everyone's employee contribution.
A wash for participating employees, but a lower legacy burden for the company.)
@Tom Maguire
Very few companies pay $15K towards insurance . More like $3K.
"Company "cost" redirected to government is $10k. Employees get a $5k raise, subject to normal taxes."
That is something different from what I addressed.
As for your "future gamesmanship", I think you are correct. Observing what companies do in general would lead one to that conclusion.
The company payments approach is economically naive. Currently companies with more expensive health benefits get competitive value by being more attractive to employees and so can hire and keep a better workforce. Companies that offer lower cost health benefits save money but get a weaker workforce. Warren's plan penalizes the better plan companies by baking in their higher costs but removing their basis for employee preference. With health care no longer varying by employer, the formerly high benefit companies would be stuck with their higher costs and permanently-boosted competitive cost structure - they would become weaker over time. Meanwhile, previously weak benefit companies would get a government-sustained lower cost-basis. This will weaken the high health benefit companies while strengthening those now offering poor health care. Also, new entrants would arise with enduring cost advantages. It is unfair to penalize the companies that are now doing best for their employees. Beyond fairness and economic inefficiency, it will unnecessarily get opposition from those companies' employees because they will recognize the approach squeezes their employers' competitiveness and so will harm their individual careers at the company. This needs a better solution, or it will be destructive of American industry and economic efficiency.
7
None of the proposals effectively address the true problem: spiraling costs. Changing the payment system from private insurance to public insurance affects only the payment, not the cost. Reducing cost requires either increasing supply or reducing demand. For example (and I'm not saying this is the only solution), supply of professionals is limited by monopolistic practices in medical education practices; loosening the monopoly could increase the number and type of professionals, thereby reducing costs.
8
@Janet "Reducing cost requires either increasing supply or reducing demand" - this may be what you learned in the first lecture of Econ 101, but it's not the whole truth. Drugs cost way more in the US than they do in Europe. Is this because of greater demand for drugs in the US? Or lower supply? No and no. It's because of the greater bargaining power of single-payer health care systems in Europe. Drugs cost even less in developing countries, because they have easier access to generics. Again, nothing to do with simplistic demand curves.
Healthcare costs are also high in the US because of skewed incentives: doctors rack up the bill by recommending unnecessary tests because they fear getting sued (defensive medicine), and also because their employers need the revenue. In single-payer systems, these incentives are less skewed. The huge, wasteful administrative overhead imposed by insurance companies is yet another cost driver. Advertising and marketing budgets of for-profit healthcare businesses, and their profit margins, are additional cost drivers (governments don't try to make a profit and they don't spend much on advertising and marketing public services).
I could go on, but I hope this is enough to convince you that "supply and demand" is not an adequate answer. If it were that simple, professors of economics and policy would have lost their jobs long ago. For lack of demand.
11
@Janet
If the system is a Medicare-type system, again: Medicare pays providers less than private insurance does. And thus one of the major benefits of Medicare goes unmentioned: its ability to lower costs. No other plan does this.
3
@Tim Clark Tim, I don't know where you get your information. I am a provider and there are private insurers paying me less than Medicare, some equal to and others more. It is MEDICAID that pays less then ALL insurers including Medicare. And few doctors accept its' ridiculous fees cause it doesn't cover overhead.
5
If as the analysis suggests, some hospitals will operate at a loss, what effect will that have on rural medical care, where hospitals already operate at a loss or on a slim margin of profitability?
How does Sen. Warren propose maintaining those facilities, many of which have already closed?
13
@Mike McClellan And what is the impact of the roughly 2.7 million people working in the insurance industry losing their livelihood?
4
@Mike McClellan
We underwrite military industries and major corporations. We can change priorities and help underwrite medical facilities. As for job losses, we see those all the time in other industries. Medical jobs may actually expand as more people have access.
17
@Mike McClellan
An excellent question. I live in a midwestern town that has a year-round population of about 10,000 (with seasonal variations caused by a smallish university). It is already extremely difficult for residents to find a local practice able or willing to accept new patients, so newcomers and those who physicians retire or leave must often travel forty or fifty miles for primary care. The regional hospital is adequate at best, but has faced financial difficulties leading to service cuts and support staff layoffs.
From what I've read about Ms. Warren's medicare for all proposal, primary care physicians would have no incentive to establish practices in rural communities like this and the margins for small regional hospitals are likely to become thinner than they already are.
I think Ms. Warren's proposal would leave rural Americans at a distinct healthcare disadvantage. But then, rural Americans never among her intended constituents anyway.
4
Don't believe the insurance industry scare mongering, Warren is right. Medicare for all is a life and death issue for many working people. This plan would not only guarantee us health security but save businesses money and boost the take-home pay of full-time workers. It's a winning idea long overdue.
8
Another issue that isn't coming into these discussions is the fact that the health insurance field is in flux. What it costs this year is not likely to be what it costs next year. The plans available this year may not exist next year. So how do we compare accurately?
@Mine2 By using averages. Aggregates. I mean, that's how GDP is estimated over the same next ten years too, even though companies haven't come and gone yet.
It's estimates. They are as accurate as can be.
2
Medicare for All might be the most efficient way to deliver healthcare to a country's citizens, but "taking away private insurance (and the jobs that come with it)" and "eliminating war funds from the military" will only result in 4 more years of Donald Trump. If you want Medicare for All in reality rather than just theory, a public option or "Medicare for All Who Want It" is the transition or approach that makes the most sense.
36
@Dillon I agree and this is Mayor Pete's position on health care. One of the many issues with Senator Warren's plan is the implicit assumption that people will trust government to take away their current health insurance and replace it with something better or even comparable. Giving people the option of Medicare seems the most sensible solution in the short term.
6
@Dillon Ridiculous. Vote for the government you want, not the one you think they want.
2
@Dillon -- You wrote: "'Medicare for All Who Want it' is the transition or approach that makes the most sense."
You may be right about that, but I think you need to consider that it is the Sanders/Warren position of Medicare for All (now favored by more than half of Americans), which has made Buttigieg's position even possible.
In order to achieve substantial positive change, it's better to promote the radical thing and then compromise for 2/3 of what one wants. If you start out compromised, then when you compromise during the legislative process, you end up with only paltry change, and to boot then also get criticized as being ineffective at getting real change done.
This was Obama's critical error (or strategy -- hard to say). Because he took the Public Option "off the table" at the very beginning of reform that eventually resulted in the ACA, what we ended up with was price increases for medical care for everyone except the very poor. So this was good for the poor in that it gave them health care, but prices on everyone else went up, so ordinary Americans ended up paying for health care for the poor, while the Health Care Cartel and the oligarchs who own it continued raking in morally obscene profits.
If we go primarily for "Medicare who all who want it," it'll get watered down and we'll have another decade of no real change. We can't let that happen. This have been going on for decades. It must stop now.
As a Brit lucky to live with a single -payer system I have a couple of observations.
Our NHS is generally very good at saving your life if you are suddenly ill. It is less good if you have a chronic but not life-threatening condition.
Many European countries have a compulsory top up insurance to cover this, and it seems that this is where a large proportion of revenue goes. Maybe this would serve you better.
Our NHS seems to be fairly well funded and satisfaction levels seem to be ok, but we are 70 years in and it’s still not perfect, maybe never will be. Don’t expect too much too quickly
11
@Steve Tittensor Medicare for all is not the NHS though - the UK is both single payer and single provider in a combined system. Medicare for all is single payer (the US government) setting prices for private providers.
7
@Steve Tittensor
I hope you don't get renal failure and need dialysis because dialysis is not started after the age of 65 in Great Britain. You just die. Death panels anyone?
Right now we have about 15% of the country's workforce in the healthcare field, and another 2% in pharma, biotech and drug distribution. Together this comes very close to the share of GDP claimed by the healthcare. Trying to reduce the whole expense as drastically as Ms. Warren suggests requires the country to fire millions of people and reduce the pay of yet more millions. She first has to think how these newly "redundant" receptionists, billers, coders, biomedical scientists, maintenance workers, nursing assistants, radiology technicians and county college teachers will make living before suggesting $14 trillions to be saved off their back.
13
@cobbler Actually, only 1.6 million people would be concerned (1.1 million from administration support staff, 500 thousands from the health insurance industry) and the answer is both M4A staff needs and newer health care jobs to meet the new demand.
Because yes, the Urban Institute estimate comes from higher health care utilization, aka higher demand, aka more jobs to meet it.
But let's ignore the job creations and only focus on job losses. Like we only focused on how much Medicare for All would cost without ever looking at how much it would save.
Scare tactics, can't live without 'em.
15
@cobbler
This is because Ms. Warren is a Socialist and doesn't really care about who this hurts as long as she can control healthcare in America. Either she is ignorant of what this will do, or she is making a grab at controlling our lives. Either way, it's all bad.
2
@François
Financial assumptions of Ms. Warren's plan (20 trillion spent in 10 years instead of 34 trillion) assume the reduction of healthcare share of GDP by about 7%. These are some real people. The French solution will be to just give them welfare (needs yet mote taxes, and makes people unhappy). Ms Warren doesn't have an American solution.
There are so many problems with Senator Warren's plan but I'll point out 2:
First, setting aside the Constitutionality and long term effects of a 6% tax on billionaires, the real issue is the problem of net worth. Jeff Bezos doesn't have $120 Billion lying in a safe in his mansion. His net worth comes from the value of Amazon stock he owns (and other investments). If you're expecting to get $7 Billion dollars out of him, where exactly is that money supposed to come from? Will he be forced to sell Amazon stock creating a immediate price hit to all the other stock holders? And considering the natural volatility of the market, when would you value that stock? Today, tomorrow, some random Tuesday?
Second, the money from increased IRS enforcement of the tax code is just silly. The IRS recently admitted they audit more low income Americans than high income Americans because they don't have the money or manpower for the complex audits that are required for high income earners. And this plan dramatically complicates the tax code for businesses, investors, and the wealthy? Where are we supposed to get all the brand new CPAs to do massively complex audits? And if all that tax money was just sitting there for the President to wave a magical enforcement wand, don't you think any president in the last 50 years would have done it?
56
@Steve Appreciate your concern for poor Bezos, but the point is, he will have to pay more in taxes, should pay more in taxes, and can afford to pay much more in taxes. I don't see how this is controversial. It's criminal how little billionaires pay in taxes.
Really? Your #2 concern with her plan is regarding the logistics of IRS enforcement?
It's sad to see average Americans come up with such sad excuses for why Warren's plan is flawed. As if the GOP's plan for healthcare is flawless.
13
@Steve Studies show for every extra $1 spent on IRS enforcement, more than a $1 is brought in as revenue. This ranges from $4 to $10 depending on the type of activity. If complexity actually decreases expected net revenue, congress can pass further laws to aid enforcement.
The tax money is just sitting there, IRS funding needs congressional approval, no magic wand needed. The IRS is purposefully underfunded by congress with executive approval, by Republican and corporate Democrats alike. As you point out, it takes more resources to go after higher incomes. You think IRS needing more money for enforcement is an accident?
11
@Visible Bezos pays taxes on capital gains when he sells his Amazon stock in taxable accounts, just like everyone else. It's his choice when he decides to sell and incur those taxes. Why would you force him to prematurely sell his stock to pay Warren's wealth tax?
3
I read the plan. As far as making the numbers work, three big things jump out: (1) Cuts in compensation to doctors, nurses, and hospital employees; (2) Forced reductions in the prices of drugs and medical equipment, with resulting cuts in wages, employment, and investment in those industries; (3) Rationing of care. This is the real meaning of "bundled payments."
In other words, we will make our health care system more like Europe's, with much lower levels of compensation to providers and leaner care for patients.
23
@James Ribe Leaner? Which European healthcare systems are you familiar enough with to make that statement? I'll tell you from personal experience that the one I have, the Spanish healthcare system, is less than perfect but still marvellous. It is first in the world in terms of transplants and seventh overall according to the WHO. Yeah, we don't have private rooms in the hospital or similar US-style luxuries, but the care and attention are top notch. As an added bonus: we ALREADY HAVE IT and it works. From here on in, the focus can be on improving it, as opposed to attaining it as an unquestionable right for everyone.
Of note, also, is the idea that, maybe if we pay doctors less, the ones who will be attracted to the profession in the future will be motivated more by a true vocation than by money.
36
@James Ribe
I live half the year in Bourre , France and frequently go to a Dr. here. The visit is 25 euros and most of the prescriptions are well under 10 euros for a 90 day supply. I sometimes wait 30 minutes for an appointment but I'm always treated courteously and thouroughly examined, no rush. Compare that to an urban USA physician's office and the fees involved. I could elaborate but you get the point Senator Warren's program is realistic and doable. Yes the pharmaceuticals and physicians will make far less money but ............maybe they'll being doing something for humanity.
9
@Kris I think that if it were only the money they wanted, they could enter other lucrative professions such as finance, tech etc., stay out of debt, get more sleep and have far fewer years of training and education.
3
It's time to stop over-compensating physicians, regardless of the reform plan. Physicians are grossly over-paid and are a massive cost to the healthcare system. Healthcare is a field for doing good for other health professionals, but it's a field for getting rich for physicians. The problem isn't the profit motive of insurers (most of which are non-profits), it's the profit motive of private, profit-driven physicians' groups. Enough.
26
@Tintin
Insurers are non-profits?
Tell that to the State of California, which felt compelled to pass a law restricting the overhead (read: expenses and profit) of health insurance companies to not exceed 20% of revenues. Medicare currently runs at an overhead (no profits, remember) of around 3%.
6
@Tintin
And how much does a doctor make? What's his/her specialty worth? How much time and money did they spend to get there? What is the value given to someone who saves lives and effectively heals? All questions I can't answer off the top of my head, but maybe those things should be considered before we just say that all doctors are over paid. And is just doctors that are over paid? What about specialty RNs? What about medical equipment suppliers, etc., etc. This sounds like the argument a five year old would make. Make your argument on facts, not assumptions. What are you, a politician?
7
Physicians generally leave medical school with mountains of debt and salaries much lower than you might expect. Moreover, two-thirds of physicians are now wage earners working for hospitals; this monumental shift of power took place in the last decade as a “feature” of the Affordable Care Act. The highest incomes shifted by and large to hospital administrators. All you will do by slashing salaries is drive smart young people into other fields and older physicians into early retirement.
2
We are paying almost twice as much per person as they do in Europe - and they actually get a slightly better health care system. Just tell us what we currently pay per person, what Fraance currently pay per person and what the Warren plan will spend per person. The details about how we get to be more like France is more than I need.
16
@Ivan
Instead of assuming that they get better healthcare in France, etc., why don't we do some REAL research and find the truth. I don't know if they do or not, but I have never seen anyone present anything in an unbiased and factual manner, just assumptions on everyone's behalf, one way or the other. And getting anything unbiased from our media is like pulling teeth from an unrestrained tiger.
Critics need to read her plan in detail. It’s smart, innovative and addresses a host of issues. I’m tired of critics who don’t read and don’t know what they are talking about. That includes mayor Pete and Amy. Slogans will get them and our country nowhere.
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@Bonnie I read the plan. In fact, I've read it three times. It's sort of like a Claymore mine. At first it just looks like a flat steel cylinder. But the more you examine it, the more you realize that, you know what? This thing could blow up a house.
4
This may well mark the downturn, if not the death knell, for Warren, sad to say.
Announcing you will be levying huge tax increases on the wealthy and business will fill the coffers of the Republicans...and also your fellow Democratic candidates.
The advertising campaigns are germinating and pivoting as I write these words.
This is why the Democratic Party, of which I am a proud lifetime member - I served in elected office myself in a predominantly Republican community - can never win in 2020 by moving forward - too much, too fast - with progressive candidates.
No matter how great these candidate's ideas, no matter how superior the candidates themselves, no matter how needed the fruition and execution of their ideas...
...you have alerted the "enemy" and they will spare no expense to defeat you and avoid those promised taxes.
It is common sense; if most of America were prepared to vote for a progressive - or even get out to vote - the country would not be so divided, nor would so many Americans have voted for Trump...and continue to support him.
Genuine, heart-felt idealism inspired me to run for office.
Common sense, sensitivity to my constituent's desired pace of change, and a healthy, eyes-wide-open respect for my opponents - and their financial power - got me elected.
Dems take note.
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Kelly Grace Smith I think we need to get your message out to the candidates. But I fear you are too spot on. Who will take it to heart? And who do you like right now?
3
@Kelly Grace Smith Why is it that the Republicans can move forward with more conservative candidates, and win, but the democrats cannot move forward with more progressive ones? Why do different rules apply to Republicans than Democrats?
This is a bigger issue (Republicans day rules for thee, but not for me) - see also, Katie Hill and Al Franken and Bill Clinton, vs. the Republican silence on Trump. But I’m asking this here in terms of what kinds of candidates the parties field.
6
@Kelly Grace Smith
With Warren and Sanders, we finally have progressive candidates whose platforms reflect values of social responsibility and compassion. Many of us have been wishing to for this option since Reagan. We can't shift away from current egocentric values fast enough.
4
Another problem I see is more "tying" of unrelated goals à la The Green New Deal.
Here Warren is tying IRS enforcement to her healthcare overhaul. Um... 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.
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@tew The faster we move to a cashless society the harder it will be to evade taxes - i.e. it will be much harder to work off the books and pay with cash.
@CDN I'd rather accept *some* corruption and tax evasion than accept e-money, which poses a real threat to civil liberties. Cash gives you the chance to buy a banned book or support a cause without the government or other large institutions tracking you. Liberty is more important than perfection.
3
Just curious, what happens to existing Health Savings Accounts? Do I get to keep those funds? If I earned $100K, but put $6K in a HSA and only paid tax on the $94K, do I have a deferred tax liability.
Some HSAs have grown quite large through maximum deferrals and market appreciation.
1
@James I don't know, but if they have any sense, they would just cease allowing new contributions but keep HSAs as is, but with no penalty for cashing out for non-healthcare related expenses, since there would be much less out of pocket, presumably. But cashing out for non-healthcare related expenses would need to be a taxable event to be reasonably fair.
They could sunset the HSAs, too, requiring they be wound down by 10 years.
2
sure losing proposition for our party. too complex.
15
When has any government program run leanly as Warren assumes (yes, she's making an ass out of you and me)? And what about fraud? We keep hearing about Medicare fraud in the news and I would expect that if everyone was covered by Medicare that would increase dramatically since there would now be more people covered to allow more opportunities to defraud the system. And what about our freedom to think for ourselves and decide what is best for us. Who believes that the government knows what's best since the Dems and Repubs have such different agendas?
9
@Mike M Hi, I’m a Canadian and from Alberta. My healthcare costs me absolutely zero dollars and that’s the same for everyone from Alberta. Some other provinces pay minimal fees such as $125 quarterly for a family. That money pays for ALL surgeries, time spent in hospice or palliative care, etc. In 2020 we will have Pharmacare nationwide. Not completely free pharmaceuticals as we’ll need to pay a filling fee up to a maximum of $25 per prescription. If we want to skip ahead of others on waiting lists and have the money to do so we also have private hospitals that you can foot the bill to go to if you wish. If we can have a system like this(being your poorer northern neighbours) I see no reason why the USA can’t follow suit. As far as I can see it’s long overdue.
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@Mike M Who gets to think for themselves and decide what is best for them? Insurance companies do that.
6
@Mike M
When has any government program run leanly? Medicare does, at 3% of claims paid. Insurers typically run around 20%, or higher (profits, remember).
Yes, there is Medicare insurance fraud. There is fraud in any insurance plan. Medicare's fraud is miniscule as a proportion of the total funds changing hands.
6
Question. If you own a small company and currently pay health insurance for your employees, you will now pay 98% of those costs to the government.
If your manager gets funding and starts a competing business in the same sector, he starting from zero wouldn’t have to pay anything to the government for his employee healthcare?
6
@Robert Broun
Why wouldn’t all companies reconstitute themselves as new entries to escape this substantial expense?
4
Still not sure how the wealth tax is going to pass constitutional muster. The 16th amendment is limited to income. While people do pay a wealth tax at the local level in the form of property taxes that's not a power the federal government is granted by the constitution. Does anyone have any clearer insight on this?
17
@Chris R Well, the Federal Estate Tax is a wealth tax.
1
Another commenter writes:
"Right now my health insurance does not cover an ambulance transport..."
A few years back, we took my youngest son to a SF emergency room, where we were told that another SF hospital specialized in his illness. We were later told at that other SF hospital that yet another SF hospital would be best, and he ended up there. Both times, I volunteered to drive him (the hospitals were all 1 mile apart). Both times, I was told that I should leave it to their ambulances, which I did. I was billed $8,500 for each of those two ambulance rides ($17,000 total). I agreed to, and did, pay $2,900 total, which, frankly, was about $2,700 more than I felt was fair. I refused to pay more, and the ambulance company simply accepted the $2,900 and went away.
Not sure whether the ambulance company was mostly at fault there, for charging $17,000 for two 1- mile ambulance rides, or the health insurance company, for agreeing to pay far too much for those two 1- mile ambulance rides -- knowing (or so it thought) that it could simply pass on most of that cost to the insured (me).
5
@Commenter
the problem with ambulances is a) they charge an obscene amount and b) they don't have agreements with most insurance companies.
Those rates often *aren't* negotiated with insurance.
2
The 6% wealth tax is unsustainable. Warren's team is relying on the fact that these budget numbers are always done on a ten year horizon. (Trump's cronies played the same games with his tax play, plus additional dashes of nonsense.)
Anyway.... fortunes rarely grow faster than 7-8%/yr over long periods of time (assuming, say, 2% inflation) (*). Spectacular increases in wealth like Bezos and Gates capture our attention, but the growth in those fortunes levels off.
Under another part of Warren's plan in this article, a billionaire's (*) increasing fortune would already be subject to annual taxation on the fortune, whether realized or not. Figure a tax rate of 35% (even though it would probably be much higher). So if the fortune increased by 7% (2% of which is not a "real" increase, but is just inflation), then the fortune increases by 5.2% after paying. After paying the 6% tax the fortune would decrease by about 1% nominal (3% real).
This really is a case of "running out of other people's money".
* Remember that 7%/yr means doubling every 10 years. Subtracting inflation, it's still 5% annual real, so doubling in real value every 12 years.
** I'm using the term "billionaire" here at face value. It seems likely the threshold would be ever ratcheted down as the chase for funds persists over time.
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@tew Speaking of running out of other people's money, please don't take the following notions here as a false equivalences so, just quickly now: since large parts of California are being burnt to bageezers, money has to be allocated to reconstruction. And then "what if" California earthquakes trash the state even more so. Where will money come from to take care of just these travesties that are occurring in only one state or our country? And in addition, reconstruction of storm damaged Eastern and lower States facing the Atlantic? Sure, I'm okay with health care for all, yet, truly please..."Show me the money!"
4
@charles moffett I would just say that the things you mention are a very good reason to keep the nation's balance sheet in better shape. We are running nearly a trillion dollar deficit while the economy is booming and nothing really major has stuck recently. This is a problem, because the very large, infrequent, but inevitable things you mention (along with many others that you don't mention) do happen and do require large borrowing to cover.
2
From the article:
"Income tax collections would increase, since workers would no longer pay part of their salaries for insurance premiums, which are not taxed now."
So workers' take-home pay would decline. Isn't that a tax on workers?
8
@Commenter We're currently paying $600 a month for employer based health coverage, which admittedly is a much lower rate than many people pay but is still a huge chunk out (especially as we were paying none before the health benefits "reform" under Chris Christie). I highly doubt that an income tax increase would be nearly $600 a month. If the income tax is even an extra $200 a month over the current rate, we still make out in the deal.
5
@Michelle Well if you're not paying the tax then the revenues won't add up. And as for making companies pay 98% of what they pay in health insurance that will mean that companies that have been paying a decent share will get stuck paying higher taxes. Also a wealth tax that Ms. Warren wants may not be constitutional and may not pass congress.
1
@Commenter Healthcare premiums are currently pre-tax and typically deducted from the paycheck. If an employee no longer needs to pay this premium, their take home pay will *increase.* However, that difference can now be taxed, so a portion of that increase will now go to the government, increasing tax collections.
So no, the workers' take home pay would not decline, it would actually increase, but tax collections will also increase.
8
Rather than a plan that covers everything, consider an actual Medicare for all—that is, extending the same benefit that the elderly receive today to all ages, with the option to supplement it with private insurance.
1) it’s a dramatic improvement in protecting citizens;
2) it is a change that is both dramatic yet incremental and comprehensible to your voters;
3) getting rid of private insurance is an ideological goal, not a health related goal; and
4) the expense is calculatable from past experience.
10
@Yeah Except that right now Medicare reimburses doctors and hospitals 40% less than private insurance does.
If you think all doctors and hospitals are going to magically just accept a 40% pay cut across the board you're dreaming.
1
I support Warren ... and it would be a good enough reason to support her ( certainly as good or better than the emotional whiplash reaction that supposedly propelled DJT into office ) just to look at the angry and dishonest reactions and to react against it from all the usual ( establishment ) suspects.
Warren has consistently been the most honest and forthcoming candidate out there, always cool-headed and always responding with facts and reason.
The basic issue here, as Bernie Sanders has mentioned also, is the countries that have come to the realization that Health Care is a human right did it because they were civilized and that was their value ... and made the costs work.
Whatever it is, this is close --> MAKE THE COSTS WORK!
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@Bruce There are no rights to others labor. The closest existing right is "if you can't afford an attorney, one will be provided to you at no cost." But that is conditional on the government prosecuting you for a crime. You don't get free legal representation (the labor of the lawyer) for any business idea you want to start or for suing your neighbor in civil court.
If the government wants to create a new source of non-tax revenue, such as leasing offshore parcels for wind development or similiar venture, using those proceeds to fund new spending is fine.
But declaring something a right and turning around and taxing Person A to pay for that right for Person B, that is not a movement towards freedom.
23
@James. The problem is: Many person A's pay little to no tax on their fortunes. Loopholes and offshore shelters cost the USA trillions in tax revenues per year. Let's tax the elite aristocratic 1%. We are never going get them to enlist in the armed forces, or do anything else us peasants do, however the could at least pay a fair share of taxes on their fortunes. Most are entitled anyway. Trust me they did not earn their inheritance. As a person B, I am tired of paying a substantially larger portion of my wages than the wealthy. You may reply and spin this perspective if you are a troll or, as a wealthy person but the truth remains the same. The top 1% simply use the rules to keep from paying their fair share. Quit whining and start contributing.
27
@James taxing Person A to pay for that right for Person B is the only thing that Governments do. You are taxed to pay for public school, even if you don't have kids. You are taxed for paying for the police, even if you are never robbed. You are taxed to pay for roads, even if you don't own a car. The list goes on to include every service any government has ever provided.
3
In the U.S. employer provided healthcare puts american workers at an additional disadvantage (on top of many others) and is one addition reason large corporations decide to shut down U.S. plants and move to Mexico or wherever. Not sure if what employers have to pay to the government under Warren's plan would be per employee (which would still disincentive to employ more workers) or if it would be more of an income tax (not payroll tax). What I would like to see happen is something like, (1) take the total amount that (say) fortune 500 companies paid in employee health care benefits over the last 5 years, (2) then divide it by the total amount of pre-tax income for those same companies reported for the same 5 years and (3) use that resulting % as a corporate income surtax and apply it to all corporations above some minimum size of employees. Additionally, I think the total cost could be cut if there were a modest deductible or co-pay, which could be waived for low income individuals. Why? Because many people with employer based medical insurance today can afford it and are already paying it, probably much higher than what it would be. If you have say a $600 or $1000 annual out-of-pocket maximum that is really not too bad for many people, and it would give predictability to medical costs. May be some years you would not reach that, but, if something catastrophic happened, you would know that was the max, and most middle income folks could handle or deal with.
2
Frankly, I'd expected a more well-thought-through plan from Ms. Warren. This has the look of something that's been hastily slapped together.
For just one of several possible examples, she'd double the wealth tax on billionaires. Since the "Medicare For All" program has been part of her overall plan for a very long time, why wasn't the wealth-tax rate doubled long ago? Did she just think of this, or what?
And why would Jeff Bezos, for example -- rather than pay $600 million a year in wealth taxes -- simply move to another country? Whether or not Bezos does that, many US billionaires will, which will greatly reduce the revenues Warren expects from this wealth tax.
Speaking of the "wealth tax," the Pollock case will almost certainly render it unconstitutional. (The 16th Amendment essentially "reversed" Pollock, but only for income taxes.) I've seen arguments pro and con on the constitutionality of proposed wealth taxes but, frankly, I can't even imagine the present-day Supreme Court either (1) reversing Pollock; or (2) declaring that Pollock doesn't make any wealth tax unconstitutional.
6
@Commenter Most of Europe has tried a wealth tax, and then repealed it due to the unintended consequences (can they really be termed unintended if the results are foreseeable to all but the true believers?).
Some people will move away, some will sell before the tax sets in, and some will find that there are no buyers for the illiquid assets (who will buy a $100MM painting for $101MM, all current values will be discounted based on the new future tax liability).
Some professionals will just demand that contracts be based on an after-tax basis. If Tom Brady wants $50MM after tax, set the contract to that. If tax rates go to 50%, Patriots have to pay him $100MM.
4
@Commenter The income tax rate was 91% in the 50s and 60s. Were we a socialist nation back then?
1
The loopholes big enough for QEII made sure we were not socialist.
1
From the article:
"Income tax collections would increase, since workers would no longer pay part of their salaries for insurance premiums, which are not taxed now."
So workers' take-home pay would decline. Isn't that a tax on workers?
1
@Commenter No, take home pay would go up because the premium that was taken out will be converted to income. That increased income would be subject to tax, but that would still leave a net increase in take home pay.
72
@Commenter You would get (1 minus marginal tax rate)*Employee premium.
$2000 premium at 25% marginal rate. Your take home pay would increase by $1500 and government tax revenue would increase by $500.
Since this is happening at marginal tax rate, the effective tax rate would rise.
1
@Commenter What JOS said. Here is an example:
Now:
Sean earns a gross income of $97,000.
Sean pays $7,000 towards health care premiums.
Sean has pre-tax income of $90,000. Sean pays taxes on $90,000 and takes home the remainder.
Then:
Sean earns a gross income of $97,000.
Sean pays $0 towards health care premiums.
Sean has pre-tax income of $97,000. Sean pays taxes on $97,000 and takes home the remainder.
Sean's after-tax income increases by $7,000 less the combined marginal tax rate on that additional $7,000 of taxable gross income.
Including things like 401(k) contributions does not change the analysis.
4
The principal cost justification has always been that, though taxes will go up, employers won't have to offer health insurance and so they'll be able to pay employees more.
But if employers must pay 98% of their health care costs in federal fees, how will those employers be able to increase employee pay? Am I missing something here?
2
@Commenter If employees don’t have to pay for coverage through their work, their take home pay will automatically go up.
5
@JOS If employers wouldn't be paying for MFA (since they'd simply cancel their private health care plans and pay the 98% annual fee), who WOULD BE paying for it? Maybe US billionaires would, through the wealth tax, but I doubt it (and many others doubt it too). Who does that leave?
Let's face reality here:
MFA would shift health care costs entirely to the federal government (FG). Right now, the FG bears some of those costs (e.g., Medicare, Medicaid, veterans' health care programs), but private insurers bear most of them (paid for largely by employers' premiums, ultimately funded through lower pay to employees). Maybe the FG can cut admin costs, and maybe it can drive tougher bargains with health care providers than private insurance companies can. That's the plan, at least. But maybe not -- the FG is not well-known for minimizing admin costs or driving hard bargains. No American should go broke paying for health care, but having the government simply take over from private insurance companies doesn't strike me as the right way to accomplish that.
One can say that the FG will save money by lowering reimbursements to hospitals and doctors. But, sooner or later, hospitals and doctors will decline to accept Medicare patients. They can now, of course, but few do because Medicare reimbursements are fairly high. If Medicare reimbursements drop, more and more hospitals and doctors will decline Medicare patients. If that happens, we'll end up with a two-tier health care system.
3
@Commenter At least my employer could negotiate with other insurance companies to get a lower premium, which would fund raises. Hard to negotiate with the IRS who wants 98% of FY2021 premium (which is already reported to the IRS) with a 3% annual increase forever.
This is government mandated charity. You will pay the same, but at least some of that money will go to pay for Bill's insurance down the street. At least if I give Bill a donation, he says "Thank You." Now it is "quiet, you wreckers and kulaks!"
From the article:
"Billionaires would pay a higher wealth tax than the rate Ms. Warren has previously proposed: 6 percent, up from 3 percent."
So Jeff Bezos would pay roughly $600 million a year. I don't think so. Bezos would simply relocate to another country, or at least many US billionaires would.
Why not just say what will happen, as Bernie Sanders does? Taxes on the middle class will go up because health care costs will be shifted from private employers and employees to the federal government. Maybe that will be better; maybe it will be worse. Either way, why not just say what will happen, as Bernie Sanders does?
3
@Commenter Jeff Bezos can move wherever he wants; but every dollar he earns in this country will be taxed if he wants to sell his stuff here in this country. If he pays no taxes here he should lose any license to make any profit in the United States.
30
@Commenter Did I say "$600 million a year?" Make that "6 billion." It's not going to happen. Maybe Jeff Bezos will pay those high wealth taxes (though I doubt it), but very few US billionaires will. They'll simply relocate to other countries. For a short while, the US may be able to tax them, but not for long.
Bottom line: The "wealth tax" won't raise much revenue, much less than its proponents predict, even if overcomes very serious constitutional challenges (notably, the Pollock case, which was changed by the 16th Amendment only for income taxes).
3
@mshighcountry, no its a wealth tax, not an income tax. So Bezos could simply move his wealth outside the states prior to the law going into effect. Presumably the law will heavily tax people trying to do this after its enacted though.
As far as the rest of it, you need to realize that we live in a global economy. You really think you're going to collect a wealth tax on people who make a profit on doing business in this country? How would that work? Right, it wouldn't. You can only tax the profit (income) that they make in the US.
The other issue is that, moving money is easy to track and tax. Wealth is hard to do this with. Even for people that keep their assets state-side, somehow, somewhere you're going to have to assess their wealth every year. For average joes with bank accounts, one house, a couple cars, no problem. The wealthy though? Yoy. You think tax code enforcement is hard now, never mind we might need a constitutional amendment to make it legal....
1
Glad to see the plan costed out. I look at it as a goal to move towards, rather than something that that will be enacted in the short-term. And even if it just sets a marker in the debate, it will move the discussion in a leftward direction. It’s an ambitious plan and one that will be attacked as politically unrealistic. But so was current Medicare when it was first introduced.
16
From the article:
"A new financial transactions tax would be imposed on stock trades."
I've always read that financial transactions (at least stock trades) would simply shift to markets that don't impose any tax. Won't this happen, so that the amount raised by this tax will be minimal?
2
@Commenter Or liquidity would dry up, or bid ask spreads would widen. High frequency trading is simply providing sources of liquidity. Taxing it would eliminate some forms of liquidity, adding to volatility.
3
@Commenter No. Other stock markets, including London's, impose a transaction tax.
Nothing unusual, though the doyens of Wall Street who have been ripping off the American people for so long will squeal.
5
I have heard many on the political left state that employer-paid health insurance premiums are part of your total compensation (usually this is part of a lecture about how single payer would result in higher take home pay). But the companies aren't going to have the chance to give you that money, since it is going to be taxed at 98%.
In other words, the middle class will be taxed on a large part of their current total compensation.
5
@James How are they being taxed on something they’re not getting?
4
@JOS There were claims that reducing healthcare costs would lead to worker raises, since the "bloat" of the system was forcing your employer to pay more on your behalf. Reduce what the employer has to pay means that the difference should show up in your paycheck.
For a small company or self-employed person, this is exactly the case. Any payments not made for insurance premiums is money available to pay out as salary.
In other words, for years people were yelling - "High insurance forces your employer to take money that should be going to you and hand it over to greedy insurance companies."
Now the claim is"Your money is no longer going to greedy insurance companies, it is going to the Federal Government. But that's not a tax?
At least an employer could negotiate with an insurance company and get a cheaper rate, allowing raises to be funded every year. It is very hard to negotiate with the IRS.
3
@James By not having to pay the premium, the worker’s take home pay automatically goes up.
2
"How to lose an election" by professor E. Warren...I think it is the height of arrogance to propose a plan that overhauls 20% of our economy and not anticipate unintended consequences. So to make this work an immigration plan has to be passed as well? Plus, a "wealth tax" has not worked in other countries....(France). I anticipate lot of billionaires migrating to the Cayman Islands!
27
@NH Doc Enjoy the Cayman Islands while the world is literally burning.
7
@NH Doc - Till they go underwater
3
@JP
MFA will do nothing for climate change.
1
Financial transactions tax on stock trades will hurt retirees.
8
@Liza And anyone who has assets in a 401K plan. That includes a huge percentage of the working population. The cost of owning stocks just increased.
4
@Liza It would also create a barrier for those working to move up the ladder to the middle class.
2
@Phillip Bingo. Warren is a millionaire from years of representing large firms through bankruptcy proceedings. She accumulated a lot of wealth during a period of low taxes on income.
Now that she has a very comfortable net worth, but below the threshold of the wealth tax, she can propose to raise taxes on income. The rules of the road that benefited her will not be available to others.
18