Medicare For All Might Be Paid For With Taxes? Forget It, Let's Keep CrapCare.

Elizabeth Warren is now the frontrunner in the 2020 Democratic primary. You can tell because in last night's debate, other candidates went after her instead of piling on Joe Biden (Tulsi Gabbard was especially clumsy about it). That comes with the frontrunner territory. But wow, the debate moderators, and CNN's panel interview after, sure chose a dumb point to spend 20 minutes on last night, trying to get Warren to say that she would have to "raise taxes on the middle class" to pay for Medicare for All. Warren instead replied that she would absolutely not sign any bill if it "does not lower costs for middle-class families" -- emphasizing the overall costs of M4A compared to America's current patchwork of private insurance, public funding, and, for far too many people, nothing.

Warren's strategy here is to emphasize that the overall costs of healthcare under M4A would be borne by increased taxes on corporations and the wealthy, and that overall, the middle class would pay less than it now pays in insurance premiums. So naturally, that larger argument has to be ignored so Warren can be accused of "dodging" the narrow question of some tax increases. As a Doktor of Rhetoric, we honestly don't know whether we'd advise her to stick to her emphasis on framing the argument around "costs," or to bite the bullet and adopt Bernie Sanders's own strategy of reframing it: Yeah, taxes would go up some, but the overall costs would be reduced, so the middle class would see net savings.

We do know it's really stupid to waste all this time acting as if Warren is hiding anything because she won't accept the narrow, misleading frame "raising taxes on the middle class" -- especially from debate moderators and pundits with six- or seven-figure salaries and the very best health insurance.

As Vox explainers, Warren supports the M4A bill introduced by Bernie Sanders, and yes, Sanders acknowledges it would have to be paid for:

Sanders said taxes would go up, but then pivoted to the same case Warren was making: total costs would decline because premiums, copays, and cost-sharing would be a thing of the past.

And while the Congressional Budget Office hasn't done the kind of scoring that would happen if the bill actually advanced in the Senate, there's definitely a case to be made that overall healthcare costs would be lower -- and as single-payer advocates keep pointing out, other industrialized countries manage to pay less for universal coverage, while the US spends the most on healthcare without actually covering every citizen. Absent a CBO score, there's research going multiple ways.

A RAND study of single-payer in New York state suggested that consumers might experience a 1-for-1 taxes-for-premiums trade under such a bill. But other studies, including one cited by Biden at the debate, indicate otherwise.

And let's not forget that Koch-funded study last year that found single-payer could actually cost trillions less than our current system; that one, again, is all about how you frame the costs and savings of shifting from our current mess. The point is, talking about it only in terms of "tax increases" totally misses the point.

There are definitely good debates to be had about shifting the US to a single-payer system, especially on what would have to be done to actually see cost savings -- like seriously regulating the costs of services, as all the European systems do, not just changing who's paying the bills.

Pete Buttigieg tried to make the case that instead of Medicare for All, we should have "Medicare for all who want it," which Warren framed as not enough, since simply introducing a more robust public option would ultimately amount to "Medicare for all who can afford it." As the campaign moves forward, that too is a debate worth having: Is it better to take another incremental step like Obamacare was, or since any half-measures will be condemned as socialism and pecked to death by Republican ducks, should we go for full single-payer as a goal and be done with it?

If one voter in a Fox News clip counts for anything, it's just possible people will see through the tax increase bullshit, since they know who Warren intends to raise taxes on: the folks who've been getting tax cuts since Reagan.

Not that we're likely to have a real policy debate at all when the question is narrowly concentrated on "will you say the words 'tax increase' or not?"

[NYT/ Vox / 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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