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Elizabeth Warren has posted her plan to pay for Medicare for All, and it's getting a pretty enthusiastic review from Paul Krugman, who says it's a serious plan whose numbers -- though you can argue about 'em -- add up. Democratic primary debates will probably still start off with a mandatory 40 minutes dedicated to bickering about whether we really want to provide health coverage for all Americans or just for more Americans than we do now, plus some bad-faith moderator questions that inject Republican fears of socialism into the discussion. But at least Warren has shifted the terms of the debate from "she hasn't said how she'd pay for it" to "will this plan work?" Warren even managed to put together a plan that doesn't call for new taxes on the middle class, although honestly, that's still a bullshit way of framing the debate.


As Krugman points out, whatever the math, no plan to remake American healthcare more equitably is going to be ready to go, out of the box, even if Warren gets elected. The real crafting of a healthcare reform bill will happen between the president and, let's hope, a new Democratic Congress. But Warren's plan passes some basic tests for seriousness as a policy proposal, says Krugman. It was drafted with the help of a bunch of serious people like former Obama health policy honcho Don Berwick, who headed the Centers for Medicare and Medicaid Services, and Simon Johnson, former chief economist at the World Bank, plus several other real economists. Warren's detailed overview is accompanied by a pair of detailed appendices analyzing the numbers and economic assumptions in further detail.

Argue all you want over the numbers, says Krugman, but they're there -- and unlike every Republican plan of the last few decades, it doesn't depend on waving a magic wand with an effigy of Ronald Reagan's dick on the end and chanting "magic of the marketplace." We may have embellished that a little.

For a pretty good overview of the details, see this very good piece by Ezra Klein, who notes that the plan definitely relies on some optimistic but not imaginary scenarios in order to add up. The US currently pays far too much to deliver healthcare to far too many people. And since other countries manage to cover everyone, at a lower portion of GDP, then it should be possible to do the same here.

Warren's M4A team projects that a single-payer system would cost a tiny bit less over 10 years than our current patchwork of public and private care does. M4A would become a hell of a lot more efficient, since you'd be getting rid of the insurance companies making a profit off paying for healthcare, and there wouldn't be a million different plans with a million different reimbursement rates. Plus, the government would regulate prices for nearly everything, as is the case in Europe and other countries with universal healthcare. Some costs would rise, since millions of people who are uninsured or under-insured now will start seeing doctors, like I did when Yr Wonkette hired me. That's called "utilization," and yes, it would add costs.

Here's Klein overview of the cost side of the equation:

Warren's team begins with a recent estimate produced by the Urban Institute, which concluded that a generous single-payer system would cost $59 trillion over 10 years — a $7 trillion increase over what we'd spend in the absence of reform. Driving that figure is Urban's estimate of a nearly 14 percent increase in health care utilization, which overwhelms the assumed savings.

In effect, Warren's team accepts Urban's estimate for utilization, but it dials up the estimates for savings.

We'll spare you the details, which Klein summarizes nicely; again, there's no voodoo, and no estimates that aren't accounted for, even if there may be arguments about the precise numbers.

As for how to pay for it, a big chunk simply involves taking the funds employers now pay to private health insurance companies and having the money go to the government for M4A instead.

To sweeten the deal for employers, she shaves their contribution by 2 percent — so whatever they're spending on private health insurance, they send 98 percent of that to the government.

Warren also blunts the argument that unions would never get behind this because they've negotiated for good healthcare at the expense of forgoing raises and other benefits. Employers with health plans in collective bargaining agreements, her plan says,

will be able to reduce their Employer Medicare Contribution if they pass along those savings to workers in the form of increased wages, pensions, or other collectively-bargained benefits [...]

That way, my plan helps unions that have bargained for good health care already, and creates a significant new incentive for unionization generally by making collective bargaining appealing for both workers and employers as a way of potentially reducing the employer's Employer Medicare Contributions.

So that's an incentive to increase union representation, too.

Having employers pay 98 percent of their current insurance costs into M4A would cover about half the program's cost; Warren covers the rest through a range of new taxes that would mostly be aimed at the rich, like a tiny per-transaction fee on all Wall Street trades of stocks and bonds, increasing the IRS's funding so it actually collects more of the tax it's owed, doubling her Eat-the-Rich wealth tax on fortunes over a billion dollars, and so on. Again, see Klein for the details. Some bits do feel a little too easy, like noting that $400 billion a year would be raised from new citizens' incomes, at present rates, if we passed comprehensive immigration reform. The numbers add up, but getting that bit done may take more than the brief paragraph in the plan.

Klein also notices a definite problem with the idea of basing employer contributions for M4A in what companies currently pay for health insurance: Companies that in our crappy current system do the right thing and provide better (and usually more costly) insurance would, under that formula, actually be subsidizing the assholes who haven't paid their fair share into the system. And Yr Editrix was definitely not jazzed by this observation about small businesses, because she IS one. From Klein:

There's an even worse inequity for employers with fewer than 50 employees. They're not required under law to provide health insurance, but a bit over half do. Warren's plan says that small businesses "would be exempt from the Employer Medicare Contribution unless they are already paying for employee health care today." That's a fairly direct penalty to small businesses that offer health insurance today: They have to keep paying a cost their competitors have dodged, but paying that cost no longer gives them an advantage in hiring.

As Rebecca pointed out in the Sekrit Chatcave, she pays for "Gold" coverage for us writers (you beloved filthy fuckaducks could help with that, you know!) and I will add that's because she is not an asshole. So we need a scheme where the literally far worse small businesses don't end up rewarded for laughing at us all the way to the bank, thank you very much.

We'd be perfectly fine with ramping up the rate for the bank-laughing companies like Walmart, who have mostly handed their employees' health costs to the taxpayer. THERE, LIZ WE FIXED YOUR PLAN, YOU'RE WELCOME.

Warren knows that Medicare for All is definitely a big proposal -- but as Klein notes, she's also happy to take on the fight for fairer healthcare that Obamacare largely avoided by trying to keep the private health insurance companies happy. We say bring it on -- if what we end up with is an intermediate step like a public option, then that's better than the current mess. And far better to fall somewhat short of full healthcare coverage for everyone than to propose half a loaf and end up with only crusts (despite the metaphor, no, I am still on my keto diet and am not dreaming of bread).

Warren also issues a challenge for other Dems: If you say we can't afford truly universal coverage, well then what exactly do you want us to set as a goal to settle for?

[Every] candidate who opposes my long-term goal of Medicare for All should put forward their own plan to make sure every single person in America can get high-quality health care and won't go broke - and fully explain how they intend to pay for it. Or, if they are unwilling to do that, concede that their half-measures will leave millions behind.

So there's Warren's plan! Now we can get to the really important part: hearing Fox News insist she wants to euthanize Grandma.

[Elizabeth Warren dot com / M4A cost appendix / M4A funding appendix / NYT / Vox]

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Doktor Zoom

Doktor Zoom's real name is Marty Kelley, and he lives in the wilds of Boise, Idaho. He is not a medical doctor, but does have a real PhD in Rhetoric. You should definitely donate some money to this little mommyblog where he has finally found acceptance and cat pictures. He is on maternity leave until 2033. Here is his Twitter, also. His quest to avoid prolixity is not going so great.

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