Elizabeth Warren proposes how she will pay for Medicare for All
November 1, 2019 9:04 AM   Subscribe

She has a plan to pay for Medicare for All, with no new taxes on the middle-class. Elizabeth Warren plans to pay for Medicare for All with a mix of taxes on the rich, and having corporations/businesses switch over the premiums they're paying now for health insurance to funding Medicare. Do the numbers add up? posted by toastyk (163 comments total) 39 users marked this as a favorite
 


Sigma7, sorry, I only just saw that.
posted by toastyk at 9:12 AM on November 1, 2019 [1 favorite]


Would like to go officially on the record here and state unequivically,
pjsky approves.
posted by pjsky at 9:12 AM on November 1, 2019 [4 favorites]


I think it’s pretty awful, for the reasons Bruenig outlines in the linked analysis. Additionally, atomizing the workforce as described would have the knock-on effect of hobbling labor solidarity.
posted by sigma7 at 9:17 AM on November 1, 2019 [4 favorites]


I’ve asked top experts to consider the long-term cost of my plan to implement Medicare for All over ten years

A 10 year implementation assumes that Democrats will control the federal government forever.

This is an immediate crisis and any plan that doesn't cover the entire population within one presidential term is not a plan. Only one candidate offers that.
posted by Rust Moranis at 9:17 AM on November 1, 2019 [28 favorites]


There's been a lot of conversation about the prospect of an overhaul of the national health care system this time around between most of the frontrunners, but how likely is this to occur? "Warren will institute a tax hike on the middle class" is scaremongering, but is it scaremongering because premiums will be replaced or scaremongering because the U.S. health care system as it exists will not be reconstructed from the ground up in 2020-2024 by anybody?
posted by Selena777 at 9:19 AM on November 1, 2019


I'm not equipped to evaluate the numbers but I sure appreciate she presents them in a detailed fashion for experts to examine. One reason I've never supported Sanders is he's always been squirrely on how to pay for all the stuff he wants government to do. Warren has never been evasive, although until today there wasn't a clear answer about Medicare-for-All. Now she's put one forward.
posted by Nelson at 9:19 AM on November 1, 2019 [19 favorites]


One reason I've never supported Sanders is he's always been squirrely on how to pay for all the stuff he wants government to do.

"Pick up a few billionaires by their little hind hooves and shake them until enough change falls out of their pockets" is good enough for me.
posted by Rust Moranis at 9:21 AM on November 1, 2019 [57 favorites]


Additionally, atomizing the workforce as described. . .

Could you expand on 'atomizing the workforce'? I'm not sure I follow
posted by Think_Long at 9:36 AM on November 1, 2019 [4 favorites]


Yeah, in the last debate Sanders was ultra clear about how he'd pay for M4A and was very forthright about how middle class tax increases would still be lower than the healthcare costs that they'd replace. Warren was the one being squirrelly in the last go-round - very understandably trying to avoid a soundbite - and everyone spent the debate exploiting that to try to make it look like she was dodging the question.
posted by windbox at 9:37 AM on November 1, 2019 [22 favorites]


It doesn't seem like the idea of morphing employer-side premium payments into a head tax would change the incentive structure for FTE vs. contractors, but the small-business exemption does. I think it would be better to get rid of that and just treat all businesses equally.
posted by Jpfed at 9:37 AM on November 1, 2019


I tried to take that "few billionaires" idea seriously for a moment. Back of the envelope from this data; Americans have about $100T in net worth. The 1% controls about a third of that. So if you confiscated all the wealth of all the top 1% right now, you'd just about have enough money to pay for 10 years of Sanders' plan's estimated cost.

The reality of funding these plans, of course, is going to rely on a lot of different sources. Warren's plans involves a fair amount of billionaire-shaking too. What I like about this essay today is she added up all the numbers to a total that seems to kinda work.
posted by Nelson at 9:37 AM on November 1, 2019 [7 favorites]




I'm not equipped to evaluate the numbers but I sure appreciate she presents them in a detailed fashion for experts to examine.

It'a worth noting that Republicans are never, ever held to this standard, instead allowed to handwave that "the tax cuts will pay for themselves" without it being noted that these predictions have never worked before, except maybe by a tepid "critics say" comment that makes objective reality sound like a matter of partisan disagreement -- which it is, but the Republicans shouldn't benefit from that fact since they're the ones in denial.
posted by Gelatin at 9:39 AM on November 1, 2019 [78 favorites]


This primary care doctor is fucking done with insurance companies trying to kill his patients and if we don't have M4A in the next half decade he's gonna burn out and go back to school to be a private pay psychoanalyst.
posted by Richard Saunders at 9:41 AM on November 1, 2019 [105 favorites]


I appreciate that Warren put in the work to explain how this would be done, because it matters when fighting the misinformation campaign currently underway.

A 10 year implementation assumes that Democrats will control the federal government forever.

Once ObamaCare (or RomneyCare, or the ACA) took hold, it has proven quite difficult for Republicans to dismantle it. They came close, once, but ultimately they failed and there are fewer and fewer avenues of attack.

When people realize they have healthcare, they are reluctant to let it go, and enough Republican politicians have so far recognized that taking away healthcare would have electoral consequences.

Part of it, too, is that Republicans have no actual plan to replace what they'd take away, except to go back to what was before the ACA, so as to undo a black President's legacy.

But most people who had insurance still have the same doctors, prices are lower, overall, more people have access, and ultimately fewer voters really want to go back to the days when preexisting conditions kept you from getting the care you need.

This is not to say that the ACA is perfect (far from it) as prescription drug costs, in particular, are onerous for many. A single-payer like approach like Medicare-for-All gets us closer to being a single customer with drug makers, as well as fixing other issues.

Warren having a real plan to pay for it turns it from a formerly empty campaign promise, into something actionable post-Election Day.
posted by They sucked his brains out! at 9:43 AM on November 1, 2019 [18 favorites]


It doesn't seem like the idea of morphing employer-side premium payments into a head tax would change the incentive structure for FTE vs. contractors, but the small-business exemption does.

Small business exemptions currently exist for various taxing policies and it has never caused companies to fragment into 50 person separate units- because splitting into 50 person units has costs too and size helps in many cases, like you know financing. That's just fear-mongering and most likely nonsense.
posted by The_Vegetables at 9:44 AM on November 1, 2019 [9 favorites]


Once ObamaCare (or RomneyCare, or the ACA) took hold, it has proven quite difficult for Republicans to dismantle it. They came close, once, but ultimately they failed and there are fewer and fewer avenues of attack.

When people realize they have healthcare, they are reluctant to let it go, and enough Republican politicians have so far recognized that taking away healthcare would have electoral consequences.

With a 10 year rollout people won't get health care. They'll get President Warren saying that the process has started, then they'll see nothing happen or see their health care get worse, then 4 years later they'll see President Cotton or President Crenshaw claim to be saving them from "the horrors of Warrencare."
posted by Rust Moranis at 9:48 AM on November 1, 2019 [23 favorites]


“Every candidate who opposes my long-term goal of Medicare for All should explain why the “choice” of private insurance plans is more important than being able to choose the doctor that’s best for you without worrying about whether they are in-network or not.“

Amen.
posted by sallybrown at 9:50 AM on November 1, 2019 [55 favorites]


With a 10 year rollout people won't get health care.

If candidates limited themselves to plans that could be implemented and finished in a single four-year term, we would never achieve the kind of structural change that both Sanders and Warren are arguing for.
posted by sallybrown at 9:52 AM on November 1, 2019 [26 favorites]


I mean, I can't help but think this is in fair part political maneuvering. Warren's detractors were saying she was being evasive giving Republicans room to say "Medicare for all can't be done without raising taxes!" (and by implication costing you tons of money.) Now Warren can say "yes, it can, and I have the numbers to prove it."

And when and if we're at a point where actual legislation is being written, if there's popular support for paying for part of it by raising taxes on the middle class a little, she can just say "Fine, if you want me to raise your taxes, I guess I can do it. Can't argue with the will of the people!"
posted by Zalzidrax at 9:53 AM on November 1, 2019 [4 favorites]


This primary care doctor is fucking done with insurance companies

I used to play in a regular poker game with ~16 doctors (across two tables, we'd consolidate to one by the end of the night). All but two were Republicans - one ended up being elected to the state legislature, actually. And despite that, every last one said he (the only woman was a Democrat) preferred dealing with Medicare over private insurers -- even though the private insurers typically paid 15% to 20% more per procedure than Medicare.

Reason was, they had to fight the insurers for every last dollar, sometimes waiting for months to get paid. Medicare paid like clockwork, exactly what they expected, within two weeks.

Unrelated, but relevant: It's worth remembering that insurance companies spend 10% to 20% of every dollar they take in on advertising, management and other overhead costs. Medicare spends less than 2% on those items. So basically one out of every five or six dollars you pay in premiums gets needlessly lit on fire before it can even pay for a Band-Aid.

And with roughly $3.5 trillion spent each year on healthcare, that's $600 billion or so's worth of Band-Aids. Or MRIs, insulin, kids' checkups, etc.
posted by martin q blank at 9:56 AM on November 1, 2019 [60 favorites]


The "how will we pay for it?" framing is bunk, I think.

We have an open checkbook for any war or tax give way to the top 1%, no questions asked. This falls under "for our common defense, promote the general welfare" for sure. I'll point to the existing NHS until the Tories destroy it by making it more like the US system.
posted by fifteen schnitzengruben is my limit at 9:57 AM on November 1, 2019 [53 favorites]


There's been a lot of conversation about the prospect of an overhaul of the national health care system this time around between most of the frontrunners, but how likely is this to occur?

It really depends--I think such a plan is likely (not guaranteed) to pass any Democratic House, but not any Democratic Senate. But a lot can change between now and 2021-2022--if Warren or Sanders sweep into office on Obama 2008 margins and they carry the Senate with them, it's possible, but I would fully expect senators like Manchin to demand significant concessions in order to vote for it.
posted by Automocar at 9:58 AM on November 1, 2019


Additionally, atomizing the workforce as described would have the knock-on effect of hobbling labor solidarity.

Finally, an outreach to the centrists in the party.
posted by Reyturner at 9:59 AM on November 1, 2019 [7 favorites]


The obvious problems are with alienating most senior voters who don't want their Medicare watered down, and alienating those who like their private insurance, a huge political loss when factoring in that the poorest beneficiaries of this proposal don't often vote. Two interesting facts in the health care debate is that a very small percentage of the population use most of the care in the long term, and many people would choose to die with dignity if they had the option in the future, which goes mostly unmentioned in political debates. Future-proofing the costs invites a two-tier approach to health care in the present, which is basically chronic disease management for those who will never recover, versus routine treatment and intervention. The lack of imagination of not entertaining private insurance in any system is misguided, and rests on the fallacy that the wealthy will maintain public care if they are forced to join it, which is also why they will kill it first. That's why any plan should have the main public costs up front, for adequate hospitals, staff, equipment and cost-controlled medicine, which all can be accessed privately to upgrade for personal choice of doctors and private hospital rooms. This actually works now, because private insurance is currently manipulated by hospital admins to pay for the entire budget that covers non-payers.
posted by Brian B. at 10:02 AM on November 1, 2019 [2 favorites]


As a Canadian who lived in the US for a while - here are some of the things I experienced.

The quality of health care I received in the US far exceeded what I get in Canada. In terms of timeliness, and willingness to use the latest tools. Also, Americans were much more active in managing their healthcare, and getting second and third opinions were encouraged. BUT, and this is a HUGE BUT - I had the best healthcare plan I could get my hands on - paid by a huge accounting firm. If I ever quit or lost my gig, I would have been FUCKED. I remember having a kidney stone MRI taken (and this is in 1998 dollars) - and my insurance company was billed $15,000!! Jebus!

When people were being let go from a technology firm I worked at (and these were Stanford Engineers) - they were literally crying, they were so worried about health care for their young families.

Ultimately, I left the US - and one of the reasons why as the crazy cost of private health care. There was no way I could have started a business or been a consultant and still have reasonable access to Health Care. Private health care chokes off the ability for entrepreneurs and small business to launch new enterprises (and people in the gig economy are getting killed...).

Health care should be a public good in my mind. There will be pro's and cons for alot of people - but the Societal good waay waay outweighs the potential cost. Get that thought straight and figuring out how to pay for it becomes a logistical process, rather than a philosophical one.
posted by helmutdog at 10:02 AM on November 1, 2019 [41 favorites]


She has a plan. Congress would have to pass it. Fine. We are already paying for crazy-expensive health care that feeds a hugely profitable industry and provides sub-adequate care to only a portion of the population. Stated simply, We Are Already Paying For It, and then some.
posted by theora55 at 10:05 AM on November 1, 2019 [13 favorites]


There was no way I could have started a business or been a consultant and still have reasonable access to Health Care. Private health care chokes off the ability for entrepreneurs and small business to launch new enterprises (and people in the gig economy are getting killed...).

This is a feature, not a bug, in the eyes of the very wealthy and their middle managers. Reduces labor costs and competition.
posted by Reyturner at 10:06 AM on November 1, 2019 [19 favorites]


I appreciate that Warren put in the work to explain how this would be done, because it matters when fighting the misinformation campaign currently underway.

I'm glad she has a plan to point to, so she can refer the next right-wing crank planted in her audience to the website when pressed about it. That said, if you are in any way hopeful that this will slow the bleating lies from the right about socialism taking away your doctor, your dog, your guns, and your lunch money, let me introduce you the the bridge I'm selling.
posted by Mayor West at 10:06 AM on November 1, 2019 [8 favorites]


Medicare paid like clockwork, exactly what they expected, within two weeks.

The Medicare and Medicaid system is like a huge, hulking beast of a ship on which everything works like clockwork because it is staffed with lots of experts who have the kind of niche expertise and no-drama attitude that long-running civil service employees have (one reason why I wince at thinking of them having to deal with Seema Verma), and there is no such thing as turning on a dime. That’s part of the reason why plans for such a significant overhaul are over a ten-year period (I’m honestly surprised it’s not longer).

I do think folding the rest of the population into that system is going to be a bumpy ride implementation-wise in ways we aren’t talking about in the campaign, maybe because the people who anticipate these effects are a smaller group. For example, a lot of hospitals jack up the procedure prices they set for private insurers (costs passed on to the end consumer) to make up for the lower prices set by CMS. What happens when CMS sets all the charges? Etc. But imo none of those concerns are reasons we need private insurers. If you look back at the history of private health insurance, it’s always been somewhat of a jerry-rigged mess of a system playing catch up.
posted by sallybrown at 10:10 AM on November 1, 2019 [9 favorites]


Two interesting facts in the health care debate is that a very small percentage of the population use most of the care in the long term

Yes. Senior citizens. They already have Medicare. Somehow we make that work ¯\_(ツ)_/¯

and many people would choose to die with dignity if they had the option in the future, which goes mostly unmentioned in political debates.

Probably because no one is voting straight-ticket "enthusiastic supporter of mass euthanasia."
posted by Mayor West at 10:12 AM on November 1, 2019 [11 favorites]


I'm glad she put out her plan, but I don't think it's numbers that will win people over. Most people don't understand big numbers. What they want to know is "will it cost ME more than it does now, and will I be guaranteed access to healthcare?" and if she can say "No, and yes" to that then it's appealing. Especially if she meets the inevitable furrowed brows/finger-shaking from opponents with the attitude "If we could go to the moon, if we could get through the Depression, if we could do those things, we can do this too." Give 'em the old rah-rah razzle-dazzle, moon-shot speech with lots of stories of Americans about how access to healthcare transforms/saves their lives.
posted by emjaybee at 10:13 AM on November 1, 2019 [5 favorites]


The obvious problems are with alienating most senior voters who don't want their Medicare watered down

This is something I never understood. I was under the impression that if you're high-risk, you want lower-risk people in your pool. If lots more (younger and presumably healthier) people join Medicare, doesn't that help Medicare? In what specific ways would Medicare be "watered down" by M4A?
posted by Jpfed at 10:18 AM on November 1, 2019 [17 favorites]


This is something I never understood. I was under the impression that if you're high-risk, you want lower-risk people in your pool. If lots more (younger and presumably healthier) people join Medicare, doesn't that help Medicare? In what specific ways would Medicare be "watered down" by M4A?

I assume these are the same people who tell us that, e.g., universal health care might be tenable in Norway, but that's only because they have so few people; it might be tenable in Sweden, but that's because it's got such a homogeneous population; it would destroy an entire sector of the economy if private insurance were greatly devalued. That is to say: the country is full of low-information voters who will happily parrot the aphorisms they hear on basic cable, because they lack the fundamental reasoning skills necessary to point out that the people pushing private insurance the loudest are the ones sitting on the board of directors at Cigna.
posted by Mayor West at 10:28 AM on November 1, 2019 [14 favorites]


This is my first day back at work after the Chicago teacher's strike. Staying out past Nov 1 would have meant everyone lost their health care. It was a huge leverage point from the employer's part and it worked to force a compromise. I get that unions have fought for health care in contracts, but if we were all in M4A instead then that's one less pain point the bosses can use against us.
posted by Wulfhere at 10:28 AM on November 1, 2019 [76 favorites]


Yes. Senior citizens. They already have Medicare. Somehow we make that work ¯\_(ツ)_/¯

Not seniors yet when talking about adult Medicaid beneficiaries.

I was under the impression that if you're high-risk, you want lower-risk people in your pool.

According to conservative sources here: In truth, Medicare is a generous benefit for retired and disabled Americans largely paid for by those who are in work — a subsidy worth an average of $13,087 per beneficiary per year. “Medicare for All” would flip this arrangement — imposing enormous tax increases on all, including seniors, to pick up all medical costs currently borne by employers and those able to work.
posted by Brian B. at 10:31 AM on November 1, 2019


Except if you read Warren's plan there's no "enormous tax increases on all, including seniors". Well the top 1% of seniors will have a tax increase, so poor Junior and Trip might have a slightly less obscene inheritance. I imagine they'll muddle through somehow.
posted by Nelson at 10:45 AM on November 1, 2019 [14 favorites]


Kevin Drum's take on her numbers here.
posted by emjaybee at 11:15 AM on November 1, 2019


Last line of K-Drum's analysis:

Everyone stay cool for a while until it’s all worked out.

Kevin, this is the Internet. Internet, Kevin. I thought you two had met before, but clearly you've got some catching up to do.
posted by tonycpsu at 11:24 AM on November 1, 2019 [5 favorites]


Maybe it's not very important, but I am curious about what's up with the 50-person threshold under which employers don't have to contribute. Why would that be desirable? It seems like a very arbitrary distortion to me.
posted by value of information at 11:48 AM on November 1, 2019 [2 favorites]


> Maybe it's not very important, but I am curious about what's up with the 50-person threshold under which employers don't have to contribute. Why would that be desirable? It seems like a very arbitrary distortion to me.

It's to make her less vulnerable to crocodile tears from primary opponents and the media about how she's trying to kill small businesses.
posted by tonycpsu at 11:52 AM on November 1, 2019 [4 favorites]


If candidates limited themselves to plans that could be implemented and finished in a single four-year term, we would never achieve the kind of structural change that both Sanders and Warren are arguing for.

On the other hand, there's a reason major structural change happens through revolutionary means at least as often as through democratic means (I'd wager it's actually far more often, but don't have stats to prove it).
posted by asnider at 11:57 AM on November 1, 2019 [4 favorites]


Maybe it's not very important, but I am curious about what's up with the 50-person threshold under which employers don't have to contribute. Why would that be desirable? It seems like a very arbitrary distortion to me.

That’s a very common threshold for all sorts of federal and state regulations and laws.
posted by Automocar at 12:27 PM on November 1, 2019 [1 favorite]


I looked at Bruenig's summary and it gave me a little laugh. Most importantly this is a regressive tax with some disguise, a point he develops a little:
The reason they are using the head tax is because they think they can trick journalists into declaring that this is not a tax, since it is expressed in dollar terms rather than percent terms. On first glance, this might seem like a stretch that probably won’t work. But it is a more plausible strategy once you consider that journalists are mostly very stupid and cannot evaluate policy claims on their own, relying instead on trusted sources and names (Warren being one of those names).
Small business exemptions currently exist for various taxing policies and it has never caused companies to fragment into 50 person separate units

Larger firms would not disappear, but there is a real effect from this sort of thing - here's a paper I immediately found on the French government's 50-person threshold for various regulations - it goes on to discuss the effects but you can see the basic charts for firm sizes on the 2nd and 3rd pages.
posted by save alive nothing that breatheth at 12:41 PM on November 1, 2019 [1 favorite]


“Every candidate who opposes my long-term goal of Medicare for All should explain why the “choice” of private insurance plans is more important than being able to choose the doctor that’s best for you without worrying about whether they are in-network or not.“

Double amen.

I'm recently re-eligible for Kaiser; yay. It'll be much cheaper than Anthem Blue Cross was, and have lower per-visit and prescription costs, plus the bonus that clinic work & doctor visits can be in the same place and so on.

Downside: My husband loses the only doctor he's had a good rapport with in the last 10+ years. The only one who believed that "the x-rays don't show arthritis" doesn't mean "you're not in near-screaming agony a few days a week." Dammit.
posted by ErisLordFreedom at 12:46 PM on November 1, 2019 [4 favorites]


We just switched insurance providers because I changed jobs and it's been such a pain in the ass to get things setup with the new system. Now my job is talking about changing insurance providers for next year so we'll have to do it again. Does anyone like dealing with this shit?
posted by octothorpe at 1:04 PM on November 1, 2019 [9 favorites]


I tried to take that "few billionaires" idea seriously for a moment.

There aren't that many billionaires in the US, according to US news (itself owned by a billionare):

> In the U.S., there are 607 billionaires, up from 586 last year and 404 in 2010

I'm only an amateur constitutional scholar, but one wonders if the whole no-bills-of-attainder article kicks in. Like, do you get a constitutional pass if you declare a bill affects only and all people named "Richard Nixon" because that is a class of 300 people?
posted by pwnguin at 1:43 PM on November 1, 2019


This plan will be smothered in the crib. Any candidate that doesn't promise to institute Medicare in their first term is inviting Republican sabotage.
posted by smithsmith at 1:52 PM on November 1, 2019 [1 favorite]


This is all well and good, but it doesn’t hit the GOP attacks square in the jaw. The GOP message machine has politicians bowing down before the tax boogeymen when taxes aren’t the fucking problem.

Costs are the problem.

Whenever Warren was asked about “raising taxes to pay for her plan” I wanted to shake her because her answers were dithering and mealy-mouthed, which is almost polar opposite of how she talks about everything else she believes in. In my head, she should say something along the lines of:

“Why are you worried about taxes? When Congress does nothing, health care costs go up. When Congress raises taxes, they go up. Did the GOP tax cut reduce cost for anyone? Of course not, they went up again!

The US pays 50% more in GDP to health care than the rest of the developed world, which translates into $4000 per person (or whatever the actual number is). How about we work towards putting that money back in the pockets of hardworking men and women and stop worrying about the false choice of higher taxes when it’s the hospital bills, insurance premiums and prescription drug prices that are out of control.”

Sadly, Elizabeth doesn’t call me for advice (or read Metafilter, apparently) so we get this plan, instead.
posted by Big Al 8000 at 2:37 PM on November 1, 2019 [8 favorites]


Not seniors yet when talking about adult Medicaid beneficiaries.

Medicaid and Medicare are two very different programs, despite the confusingly similar names.
posted by They sucked his brains out! at 2:45 PM on November 1, 2019


It'd be lovely if there was a little push-back against the idea that the ONLY question that needs to be asked about political policies is whether you have to pay taxes to support them. If you elect Republicans and you get an eighty dollar tax cut and they destroy social security, you did not come out ahead. Likewise if you elect Democrats and you pay some taxes and you stop paying high premiums for lousy insurance, and everybody stops living in fear of being bankrupted by minor medical emergencies, you got a good deal. If we're ever gonna get this mess back under control, Democrats have got to stop following the Overton window around like a string of baby ducks, and start dragging it back in the other direction.
posted by Sing Or Swim at 2:49 PM on November 1, 2019 [17 favorites]


We were snookered the moment we accepted "taxpayer" as a synonym for "citizen." Quite apart from the fact that a lot of non-citizens pay taxes (unacknowledged in this rhetoric), the Reagan/Thatcher formulation casts the government as the opponent of the people rather than as their representatives. And then, naturally, they made it so.
posted by sjswitzer at 2:56 PM on November 1, 2019 [12 favorites]


I think her plan is really smart. A lot of people didn't buy that once businesses stopped paying for healthcare it would result in pay increases. This plan addresses that concern by having businesses continue to pay for healthcare. In addition, some really, really rich people pay more in taxes and we cut some military spending. It sounds doable. It changes the least conceptually. Best of all, there's no tax increase.

Better, cheaper, go anywhere healthcare you don't have to pay taxes for? Sign me up.
posted by xammerboy at 3:22 PM on November 1, 2019 [5 favorites]


One thing I don't understand is the ten year rollout plan. Isn't one the benefits of having everyone on the same plan that it's easy to implement? Also, what's the plan to get this through the senate?
posted by xammerboy at 3:27 PM on November 1, 2019


Medicaid and Medicare are two very different programs, despite the confusingly similar names.

Of course, and Warren's plan is essentially Medicaid for all, not Medicare as we know it, because the existing system will take on all Medicaid patients and then endure complaints of downgraded care for routine treatments that currently receive prompt attention with insurance. It's possible to have all three for everyone by expanding Medicare as the opt-in for those who can afford the monthly premiums or coinsurance. It's useful to recall that politicians replaced "single payer" with "Medicare for all" as a PR move, not necessarily modeled on current Medicare at all.
posted by Brian B. at 3:47 PM on November 1, 2019 [1 favorite]


The budget information is based on a 10-year timeline because that’s the timeline the CBO and the Senate use for budgeting purposes. She says in the bottom of the article that she’ll explain the implementation timeline in a few weeks.
posted by Huffy Puffy at 4:01 PM on November 1, 2019 [3 favorites]


Of course, and Warren's plan is essentially Medicaid for all, not Medicare as we know it, because the existing system will take on all Medicaid patients and then endure complaints of downgraded care for routine treatments that currently receive prompt attention with insurance.

Medicaid is a different program entirely, managed by individual states, with a different funding structure entirely. Medicaid patients would be folded into Medicare; it would effectively cease to exist, as proposed. I honestly fail to see how Warren's plan has anything to do with Medicaid?
posted by They sucked his brains out! at 4:53 PM on November 1, 2019 [8 favorites]


The budget information is based on a 10-year timeline because that’s the timeline the CBO and the Senate use for budgeting purposes

Yes, remember the TCJA (and other similar bills) had a bunch of expiring tax cuts at the 10 year mark, so official analysis would downplay the deficit incurred.

Warren does not appear to be doing anything similar here, of course, but the "10 year outlook" is a common thing and it's always good to at least look out for those who exploit that [again, I don't see anything like that here].
posted by thefoxgod at 5:12 PM on November 1, 2019 [1 favorite]


I generally think releasing detailed plans are a bad idea. It's going to give people something to nitpick and the plan itself never becomes law because the plan you try to implement in two years will have different calculus and politics so the detail will change.

But Warren's brand is that she has a plan so she needed to release this. I'm even somewhat optimistic she'll be able sell it--she connects her policy wonk side to her rhetoric and vision and makes voters understand why it helps them better than anyone I've ever seen.

I made the mistake of listening to NPR on the way home though. They literally gasped at the price tag. Do they respond that way to any of Trump's crap? I swear to god the fact that on some level they think their personal predilections are progressive does so much damage.
posted by mark k at 7:20 PM on November 1, 2019 [7 favorites]


I'm pretty sure she can sell it, but I don't think it will get through as is. Any real plan will need to pass through budget reconciliation, which only needs 50 votes in the Senate. This probably means spending for healthcare or a green new deal, etc. will have to come from military spending. But it's important people know we can have Medicare for All and it doesn't have to raise taxes for the middle class.

Also, Warren just called this plan the biggest tax cut in history. Now, that's selling your plan! Meanwhile Biden is ripping on Warren as not being a real democrat and says her math is fuzzy.
posted by xammerboy at 7:30 PM on November 1, 2019 [5 favorites]


I generally think releasing detailed plans are a bad idea. It's going to give people something to nitpick.

Warren: "I'm going to raise taxes on the rich."

Republicans: "Yeah, but how are you going to pay for it, Missy."

You can't win that game with Republicans. They never have to make sense.
posted by JackFlash at 7:41 PM on November 1, 2019 [6 favorites]


That said, if you are in any way hopeful that this will slow the bleating lies from the right about socialism taking away your doctor, your dog, your guns, and your lunch money, let me introduce you the the bridge I'm selling.

No, that wasn't my point, at all. That isn't what I said, either.
posted by They sucked his brains out! at 7:50 PM on November 1, 2019


Matt Bruenig again: What Is a Middle Class Tax Hike? Am I Losing My Mind?
posted by Cezar Golescu at 9:12 PM on November 1, 2019 [3 favorites]


That is a good link, he just wrote the post I was gonna comment here but by someone who actually knows the topic. A real timesaver!

And the thing is, if I kinda know the basic concept of what a "tax incidence" is, I'm pretty sure Elizabeth Warren knows it much better.

Primaries are just the time to lie to the base I guess..
posted by save alive nothing that breatheth at 9:22 PM on November 1, 2019


Saw this comment on WAPO, and thought I would post it here:

Proposed Tax:
1. 3% tax on total compensation for any employee. Paid for by the employer.
2. 3% tax on Adjusted Gross Income on your personal income tax return.
- Replaces the existing 1.45% rate both the Employer and Employer pay.
- Reduces amount everyone below top 10% pays. No deductibles, copays, or premiums.

The "Middle Class" (40% to 60%) Currently Pays:
- $800 for Medicare (and get nothing for it)
- $700 in additional "premium sharing" for their insurance
- $500 per year in deductible and copays.
= $2000 (or 4% of the average $55k income)
M4A would cost them $1650, and be better.

Employers:
- Fixed medical costs ($2200 average employee, vs close to $3000 today).
- No administrative costs or headaches
posted by xammerboy at 9:53 PM on November 1, 2019 [2 favorites]


Is that right?
posted by xammerboy at 9:56 PM on November 1, 2019


The Breunig columns are pretty interesting. In the first, he basically concedes that Warren's plan is fine, as long as it eventually transitions to a more progressive payroll tax.
I do think a temporary head tax that transitioned into an employer-side payroll tax could work. To do this, you would start it off the same way Warren does by requiring every employer to pay 98 percent of their per-employee health care costs prior to Medicare for All (call this the maintenance-of-effort (MOE) payment). Then, for every subsequent year, you would phase-in the payroll taxes by a couple percentage points a year, allowing employers to deduct that payroll tax from their MOE Payment. After a few years of this, the payroll tax would get large enough to subsume the MOE Payments, which will be eliminated.
In the second column, his complaint is not about the economic feasibility of the plan, but more that it is unfair that the media seems to accept Warren's framing that an employer head tax is not a tax. By that logic, he argues, payroll taxes and VATs are also not taxes since they are equally indirect.
If an employer-side head tax solves the problem because middle class health care costs are still lower after its imposition, then every M4A financing proposal I have ever seen solves the problem and does it in a much more progressive way than Warren has... The idea that Warren’s specific cost-saving indirect middle class tax hike — an employer-side head tax — is the only thing that counts as solving the M4A Financing Problem is clearly nonsensical. And yet here we are with the least progressive M4A funding proposal I have ever seen being championed as the only one that solves the problem.
In both cases, these are not so much criticisms that the plan doesn't work, as that it is cheating in its implicit competition with Sanders's (deliberately vague) M4A payment approach. And he's right, it's totally unfair if the media accept this framing that it's not really a tax, in the same way they somewhat illogically accept the framing that Social Security is paying into a "trust fund" instead of just being a tax and benefit. But I have to say, as a frequent critic from the left -- if the cost of M4A is a little bit of creative framing and pretending that it won't eventually transition to a more progressive tax, that's fine by me. After all, if Breunig doesn't pass the progressive tax part immediately, then his transition plan is exactly the same as the head tax plan as passed on day 1, and in both cases revision may or may not happen depending on the vagaries of subsequent electoral margins. But in the meantime, leading up to day 1, the Warren plan can engage in the productive "deception" that the 98% head tax is not really a middle class tax, just a replacement payment, and if the tut-tutting centrists actually buy it, that's a pretty great accomplishment in creative framing.

I'd much rather just do what he seems to want, declare it a worthwhile cost, and pass a proper progressive tax at the outset. But I also see the benefits of creative framing. The only issue really that I see is that, while it's a good jujitsu move for arguing with the right (center-left) flank, the left flank (such as Breunig) is going to call it a regressive tax that costs more than just a straightforward progressive tax, and I don't know how Warren is going to manage to maintain the illusion that this is not a tax in the mushy minds of the center-left while the far left is repeatedly calling it a (regressive) tax. I guess the way to thread the needle is to stick with calling this a non-tax, but agree in some vague way that the ultimate goal is to transition to progressive taxation.
posted by chortly at 10:18 PM on November 1, 2019 [3 favorites]


I finally made it through the original post. The policy suggestions actually seem super great and exciting. It sounds like in addition to universal coverage, she is really focused on fixing all of the anti-competitive problems and administrative bloat in the existing system, which seems extremely valuable. An unnecessarily complicated and regressive tax to pay for it -- fine, if that is really somehow politically necessary.

I haven't been following the primaries or candidate platforms at all but now I am officially impressed with Warren.
posted by value of information at 11:53 PM on November 1, 2019 [10 favorites]


helmutdog

I remember having a kidney stone MRI taken

There is zero reason for kidney stones to require a MRI. Kidney stones are radiopaque and will show up on XR or (non-contrast) CT, both of which are cheaper procedures. There's no reason for an MRI outside of pregnancy, and even then an ultrasound is quicker and cheaper.

Really, the only reason for imaging on a suspected kidney stone is to confirm it is of a size that will pass naturally (or with meds like tamsulosin). A MRI for a kidney stone is an example of an necessary procedure that a cadillac insurance plan might pay for, but has no diagnostic value.

sallybrown

a lot of hospitals jack up the procedure prices they set for private insurers. What happens when CMS sets all the charges?


This is addressed here:
Under my approach, Medicare for All will sharply reduce administrative spending and reimburse physicians and other non-hospital providers at current Medicare rates. My plan will also rebalance rates in a budget neutral way that increases reimbursements for primary care providers and lowers reimbursements for overpaid specialties. While private insurance companies pay higher rates, this system would be expected to continue compensating providers at roughly the same overall rate that they are currently receiving. Why? This is partially because providers will now get paid Medicare rates for their Medicaid patients — a substantial raise. But it’s also because providers spend an enormous amount of time on billing and interacting with insurance companies that reduces their efficiency and takes away from time with patients. Some estimate that hospitals will spend $210 billion on average annually on these costs.
The nonpartisan Institute of Medicine estimates that these wasted expenses account for 13% of the revenue for physician practices, 8.5% for hospitals, and 10% for other providers. Together, the improved efficiency will save doctors time and money — helping significantly offset the revenue they will lose from getting rid of higher private insurance rates.
Under my approach, Medicare for All will sharply reduce administrative spending and reimburse hospitals at an average of 110% of current Medicare rates, with appropriate adjustments for rural hospitals, teaching hospitals, and other care providers with challenging cost structures. In 2017, hospitals that treated Medicare patients were paid about 9.9% less than what it cost to care for that patient. The increase I am proposing under Medicare for All will cover hospitals’ current costs of care — but hospital costs will also substantially decrease as a result of simpler administrative processes, lower prescription drug prices, the end of bad debt from uncompensated care, and more patients with insurance seeking care.

So the idea is that MFA would reimburse more than current Medicare rates, and definitely more than Medicaid rates. Also that overall costs would come down by establishing consistent, universal rates, which would obviate administrative costs and reduce other external costs.
posted by Panjandrum at 1:54 AM on November 2, 2019 [7 favorites]


I'd much rather see these kinds of schemes implemented at the state level first.
posted by phenylphenol at 5:13 AM on November 2, 2019 [1 favorite]


I'd much rather see these kinds of schemes implemented at the state level first.

It would seem that you can't implement "Medicare for All" unless you implement it for everyone. One of the major benefits is eliminating all the state-level having-to-regulate insurers overhead. Frankly, I would be happy if NYS didn't have to use State tax dollars to oversee something that should be done at a national level.
posted by mikelieman at 5:26 AM on November 2, 2019 [5 favorites]


I'd much rather see these kinds of schemes implemented at the state level first.

LOL at the idea that those of us in states that the GOP controls with voter suppression and gerrymandering will ever see them, then.
posted by sciatrix at 5:38 AM on November 2, 2019 [17 favorites]


Will there be a jobs training program for the vast swath of insurance office workers that'll be put out of work or are they to become federal employees torturing the lives of the newly insured?
posted by sammyo at 5:41 AM on November 2, 2019


Well that was snark but there seems to be a shortage of vision in a plan that takes the total cost estimate and reassigns that cost to a slightly different funding cycle.

One issue that seems to be not included is that the change in tech is just expensive, to absurdly oversimplify, we get a cure for cancer under the new plan but it requires 20 full time doctors and highly trained biotech workers per patient, that's untenable but do we just let folks die?

Well that's wrong too, and it may be terminology. Insurance was originally pooling resources for exceptional events. Most ships would return but when one failed it would ruin a single owner so all the owners pooled funds to bail out that victim of a storm.

That is not the case, everyone uses some or most or more of their contributions. Can anyone rationally take that pool and redistribute it without vast corruption? Can we not help everyone that needs help? Oh gawd robots, we need more robots.
posted by sammyo at 5:55 AM on November 2, 2019


There are plenty of valid, valuable critiques to make on pretty much any policy.
But people saying Warren's M4A plan has a "ten-year" phase-in when it's just using the ten-year budget window: please stop embarrassing yourselves.—@ddayen

Oh God is this where people got the “ten year transition” from? Congressional budgets are done in 10 year increments, people. The bill she cosponsored still calls for a 4 year transition. —@ryangrim
posted by Pater Aletheias at 8:52 AM on November 2, 2019 [12 favorites]


All state governments are terrible. No exceptions. Don’t leave anything important up to the states, ever.
posted by Huffy Puffy at 9:22 AM on November 2, 2019 [3 favorites]


> All state governments are terrible. No exceptions. Don’t leave anything important up to the states, ever.

This is waaay to categorical a statement. All else being equal, the federal government should have broad power to set basic standards in a wide variety of policy domains. Still, in times like these, state governments are often a bulwark against the worst excesses of the executive branch. I don't have to love federalism in order to grudgingly accept that it's saving lives and pushing back against fascism for those fortunate enough to live in states with sane state governments.
posted by tonycpsu at 9:37 AM on November 2, 2019 [6 favorites]


All state governments are terrible. No exceptions. Don’t leave anything important up to the states, ever.

As a Californian, I could not disagree more. While every state has its flaws (hello, wildfires!) I am, for the most part, proud of my Governor and state legislature, and I love one of my Senators (Harris) and my Representative (Mark DeSaulnier). And, well, I'm okay with my other Senator, lol.

But saying "All state governments are terrible!" is not only cynical, it's actively harmful to the morale and the efforts of those of us who want to make our states better places to live. Think of all the states we flipped blue in 2018. Think of how much better life for people in places like Maine and Nevada are now that their governments are blue and not red.

I will say it again: cynicism and fatalism are actively toxic and dangerous.
posted by Rosie M. Banks at 10:00 AM on November 2, 2019 [15 favorites]


Setting the bar to "nobody complains" seems pretty deck-stacky to me. The bar in 2019 shouldn't be "Good" in some absolute sense, but "better than Trump".
posted by tonycpsu at 10:01 AM on November 2, 2019 [3 favorites]


Let me back away from my deraily cynicism (Texas, Louisiana, Oklahoma, Rhode Island, Arkansas, Alabama, Florida, Tennessee) and just say that if you do it federally you only have to get it right once, but if you involve the states you have to get it right 50 more times.
posted by Huffy Puffy at 10:14 AM on November 2, 2019 [2 favorites]


(And anyway Warren and Sanders have consciously chosen the single-payer Medicare model rather than the federal/state Medicaid model, so they’re not involving the states in implementation anyway, so I’ve antagonized everyone for no reason. Sorry.)
posted by Huffy Puffy at 10:36 AM on November 2, 2019


All state governments are terrible. No exceptions. Don’t leave anything important up to the states, ever.

Spoken like a true southerner.
(I JEST)

Some would say all governments are terrible and one should never put anything in their control, etc, etc. But as a naive optimist (somewhat less naive than I used to be), I would like to think that statements of this type write out many alternate futures where sensible people, acting in good faith, can fix things.

Nothing , unless you are talking about the metaphysical, is good or bad without a reason. If governments are bad, FIX GOVERNMENT. This is a problem to be solved. If you don't believe government can be fixed, then, we may just as well buy our ARs and hunker down for a long de-evolution.

I would hope that the MeFi community are not resigned to that path yet? We're creative problem solving type people, right?

As far as Warren v. Sanders health plans are concerned, I don't think any one plan is perfect but I like the fact that Warren has understood the criticism of her position and has done the work to apply a thoughtful solution. I believe both candidates approach their work with similar intent, so if you are a progressive considering this direction it comes down to who you believe can carry their roadmap ahead with determination and grit. Why I tend to favor Warren is that she has proven she can make big implementations work and that she can carry on her ideas ahead in good faith while navigating the actual process of getting things done. If Bernie is the nominee, FINE, I'm happy to support him as well. Frankly, I'd love a world where they run together and share the presidency.
posted by BigBrooklyn at 10:58 AM on November 2, 2019 [8 favorites]


Health care is a national market and national problem. Trying any of this at the state level is really challenging and inherently limits the tools you can use.

* * *

A short twitter thread catches Politico, using a private equity health care type to criticize the plan. It describes her only as Obama's "deputy chief of staff" as opposed to a beneficiary of the current system.

If she gets the nomination Warren's campaign is going to drive some really weird double standards on coverage. Far more than we see now.
posted by mark k at 11:10 AM on November 2, 2019 [15 favorites]


Would Warren be catching as much grief for "how will we pay for this?" etc. if she were a man? Enquiring minds want to know. I, personally, think she's the best candidate we've had in ages (also Kamala Harris, but her momentum has slowed).

Bottom line is, we spend far too much on health care and get far too little back. Our actual health outcomes are dismal compared to other wealthy countries. Per Wikipedia: Although the United States was spending more on healthcare than any other country in the world, more than two women died during childbirth every day, making maternal mortality in the United States the highest when compared to 49 other countries in the developed world.

Maybe a few, very lucky, people get absolute "Cadillac" care they might have to downgrade, but right now a lot of people get "old junker exploding Pinto" care or no care at all. The ideal, I think, would be to make "Chevrolet care" or "Toyota care" a baseline and then anyone who wants or needs Cadillac care can pay for it with supplemental policies.
posted by Rosie M. Banks at 1:52 PM on November 2, 2019 [8 favorites]


I agree with Warren on this, but I want to follow this line of thought...

Those who oppose it, tell me why the current system works. Because it doesn't, unless you are in the upper middle class or higher. I make decent money, but I seriously doubt anyone on here is in the upper class. Those of us in the middle class are often being played by the upper class to turn against the lower class while the upper class pilfers.

Our medical care system in the US is a laughing stock compared to the rest of the world. A joke. We are the richest country on earth (currently), yet we can't (or honestly, won't) take care of those who need help. It says a lot of a culture in how they take care of the less fortunate. Can we, as a country, be proud of how we treat our, instead of demonizing them?

I bring this up because I have seen on Metafilter people comment who live in some sort of masturbatory, libertarian fantasy where helping the poor is turned into "they need to pull themselves up by their bootstraps" instead of understanding that even your ZIP code can determine your social outcome. Especially us white people.
posted by Chocomog at 4:12 PM on November 2, 2019 [13 favorites]


Would Warren be catching as much grief for "how will we pay for this?" etc. if she were a man? Enquiring minds want to know. I, personally, think she's the best candidate we've had in ages (also Kamala Harris, but her momentum has slowed).

Abso-fucking-lutely not. I would be less adamant about this, but we have a rare natural comparison study in that Bernie Sanders has been arguing for pretty much the same plan, except with even more vagueness about the pay-for aspect, and has gotten zero criticism for it.

The difference? First, obviously, gender.

But also -- I think that Bernie's a useful stooge to the conservative (in the status quo sense, if not necessarily the political sense) forces in the healthcare and insurance industry. They can point to him and scream socialism and anarchy and blood in the streets. And they know that he's rather incapable of working well with others. How would he be able to wrangle anything through Congress?

Liz Warren, on the other hand, scares them much more. She's got a similar anti-establishment fire and similar ultimate goals, but she knows how to work within bureaucracy and the politics of Washington and all that shit to get things done.
posted by tivalasvegas at 8:06 PM on November 2, 2019 [17 favorites]


Abso-fucking-lutely not. I would be less adamant about this, but we have a rare natural comparison study in that Bernie Sanders has been arguing for pretty much the same plan, except with even more vagueness about the pay-for aspect, and has gotten zero criticism for it.

I don't entirely disagree with your other points, but it is worth pointing out that Sanders has routinely said "and yeah, we'll raise your taxes, so what, you'll get healthcare that works and you won't pay premiums." Warren thinks (not unfairly) this isn't a winning argument, so she's been trying to point out that the question of "BUT TAXES YOU RAISE DEM?" is stupid, but it hasn't been getting enough traction. So this is her plan B.
posted by mightygodking at 8:40 PM on November 2, 2019 [1 favorite]


Re: The per-state implementation. It's not impossible, Canada does it that way. But it comes with a federal mandate and funding. The provinces can't just say "nah."

Re: The "Cadillac" thing. I think it's a bit funny when people talk about waits for non-emergency medical procedures. A system with no waits is by definition way over-provisioned. Off-peak, do all those people and machines just sit there? How long the wait list is is something that can be tuned. Canada's system is pretty good, though there are waits for some things. More money would shorten those lists, but how short do they get before that money could be better spent elsewhere? I don't know the answer to that, and I don't think many people ever even consider it. I do know that the money spent to give certain privileged people instant access to unnecessary procedures is entirely wasted and much better spent creating access to necessary treatments for everyone. That isn't something private insurers and hospitals will ever do. "Rationing" is how you get fair, efficient health care.

Re: Americans in general. Why are so many of you determined to never make any positive changes? Big projects never turn out precisely as planned. Flexibility and adaptability are the name of the game. Warren's plan, even under the best circumstances, wouldn't be delivered in exactly the form planned, but at least there's a plan! Y'all are just looking for excuses to stop the ball rolling.

Liz and Bernie are widening the Overton Window to the point that the discussion can now be had in public among respectable people. At the very least, appreciate that.
posted by klanawa at 8:49 PM on November 2, 2019 [7 favorites]


I don't entirely disagree with your other points, but it is worth pointing out that Sanders has routinely said "and yeah, we'll raise your taxes, so what, you'll get healthcare that works and you won't pay premiums."

He's basically said that we'll soak the rich and that will pay for it. I think his plan calls for slightly higher tax rates on the very wealthy than Warren's -- but she's also more realistic about the fact that actual universal healthcare will also require more than just raising income taxes at the top end.

This is all sort of an academic discussion, since any initial proposal will be significantly changed if it ever makes it through Congress, but it's indicative of how they approach leadership, their theory of governance. I think Warren is threading the pragmatic/idealistic needle better than anyone else, and that's why she is the best hope to both beat Trump and achieve progressive goals.
posted by tivalasvegas at 9:21 PM on November 2, 2019 [3 favorites]


Bernie's payment plan makes more sense to me and is cheaper overall, but Warren's plan makes more political sense to me. People were not willing to pay more taxes for healthcare. Period. A significant portion of the left will vote only for medicare for all, and not a public option. Period. This is the position she needs to take to win the Democratic primary.
posted by xammerboy at 10:33 PM on November 2, 2019 [3 favorites]


I'd much rather see these kinds of schemes implemented at the state level first.

Private insurance companies effectively have state monopolies, already. One might say, without hyperbole, that a per-state scheme was tried and is already known to have failed, by virtue of the situation we are in presently, which demands a single-payer approach at a federal level.
posted by They sucked his brains out! at 11:22 PM on November 2, 2019 [7 favorites]


I do know that the money spent to give certain privileged people instant access to unnecessary procedures is entirely wasted and much better spent creating access to necessary treatments for everyone.

I have a chronic disease, and I believe I am getting treatments from our current health care system which I would not get from a fairer system. But y'know what? I would take the fairer system over the status quo.

Because my condition is on a track that will eventually take me out of the workforce. When it does, it is a pre-existing condition that could render me inelegible for the insurance that covers normal healthcare for things that are more treatable. Or make that insurance prohibitively expensive. All that stands between me, and that fate, are my job (which my condition's gonna take away) and a couple of senators from states I don't even live in.

People with chronic illnesses don't get exempted from having other illnesses, in fact much the reverse. I could have a heart attack or a treatable cancer or get diabetes or get in a car accident, just like anyone else. I still need insurance to pay for that stuff.

My condition is worsened by stress. It seems likely to me, that reducing my stress could do more to slow the progression of my disease, than all these expensive treatments do. Maybe I would get a little better, or stop getting worse as fast, if I could spend more time in phiysical therapy and less time sitting at a desk taking insanely expensive pills.
posted by elizilla at 8:42 AM on November 3, 2019 [9 favorites]


OK, here is a comment about a head tax vs. a percent-of-income tax on the employer side. This was the express subject of the "counterpoint - unworkable and bad" comment way up top, and also many comments between then and now.

As an employer*, I actually think that a head tax is more directly comparable to the system we have now, and it would result in less disruption to at least start this way. Because we provide health insurance as a benefit and the thing is, the insurance cost of any given employee has little to do with their salary. It has way more to do with their age, gender, and the ages and genders of their spouse and dependents, none of which we are allowed to consider during hiring decisions, of course.

As a particular example, we have a late-20s employee with a professional degree and no spouse or dependents. We also have an administrative employee with 4 kids. The latter has a lower base salary but substantially higher employer-side health insurance costs. If we were to implement Warren's plan, it would be WAY easier and more predictable for us to do the per-head "percentage of status quo ante" calculation, which is relatively stable month to month and year to year, and does not depend on promotions, bonuses, etc.

This actually makes me even more optimistic about Warren because it appears she is taking the practicality of all stakeholders into account. As a matter of justice, we should eventually get to a place where the health care tax is income-based and progressive; as a matter of implementation and transition, the head tax makes a lot of sense.

* I'm "an employer" in the sense that I am a part owner of a small company that employs some people, requiring me to make many, many (OH so many) HR and benefit decisions. I adamantly reject the Republican JAHB CREATORZ! rhetoric and I don't mean to assert any more authority than that.
posted by Joey Buttafoucault at 4:05 PM on November 3, 2019 [15 favorites]


Crap. Sanders responds with essentially a literal Republican talking point, saying Warren's MFA plan would have a negative impact on job creators.

Sanders: “I think that that would probably have a very negative impact on creating those jobs, or providing wages, increased wages and benefits for those workers”

I don't know who advised him on this line of attack, but that was truly terrible advice. There are so many other ways to critique Warren's proposed pay-for. He basically just cut the GOP an ad for the general.

I really can't describe how disappointed I am in Bernie right now.
posted by donttouchmymustache at 9:05 PM on November 3, 2019 [9 favorites]


FWIW, I couldn't find a real transcript of Sanders's full response, but here is a junky, questionable-provenance image of a transcript from Twitter.
posted by chortly at 10:31 PM on November 3, 2019 [1 favorite]


Thanks for that, chortly. I see that Sanders seems to be explaining the head/payroll tax argument from his perspective, but he could have focused on the progressive/regressive taxation argument instead of the critique that her plan may have a negative impact on job creation and wages, which is really a variant of trickle down nonsense and encourages terrible framing that can really hurt the entire progressive platform.

Meanwhile, even Warren's response to his criticism is so much more positive, inclusive, and helpful at re-framing the argument in a way that helps progressives.

Warren: "Bernie may have a different vision of how to pay for it, but let's be really clear, Bernie and I are headed in exactly the same direction," she told reporters.
She also added: "Anyone else who's run for President, where's your plan to deal with that $11 trillion that families are going to pay? ... Bernie and I, we’re out there for strengthening America's middle class. I love it."

I know Bernie is being told he needs to criticize her pay-for in some way in order to get some traction, but sometimes I'm convinced that Bernie is thriving to some degree in spite of his political advisors than because of them, or less charitably, Bernie's personal ambition may be hurting him and the movement. And the fact still stands that he hasn't been pushed to come up with a detailed pay-for the way Warren was.

Full disclosure, I have to agree with Ady Barkan (link in the FPP text above) that Warren's plan is a tremendous achievement in the fight for single-payer, and regardless of the election results in 2020, will have a tremendous impact in bringing the movement forward more than any other single action by any candidate.
posted by donttouchmymustache at 11:12 PM on November 3, 2019 [10 favorites]


Abso-fucking-lutely not. I would be less adamant about this, but we have a rare natural comparison study in that Bernie Sanders has been arguing for pretty much the same plan, except with even more vagueness about the pay-for aspect, and has gotten zero criticism for it.

Seems to have been getting a lot of criticism by a lot of people claiming he's been vague on payment details. If you mean in the media, like Bruenig's piece, mostly Sanders doesn't get mentioned in articles about primary issues - except after debates, to attack him for being loud.

If you look at the image Chortly links, Sanders's response to this issue is very pointed and very accurate. A flat $9,500/employee tax, and it is a tax, punishes employers who hire working-class employees significantly and specifically, and serves only to depress employment numbers - someone who works 2000 hours at $15/hour costs $30k in wages, but now costs $39.5k to hire. Or worse, since independent contractors specifically do not count as employees for Warren's tally, this will provide a perverse incentive for mass misclassification. A payroll rate tax, like Sanders has proposed, avoids all of this.

Sanders put out the details of his wealth tax plan months ago - which is significantly harsher than Warrens, scales much quick and much higher, and doesn't have the marriage loophole hers does - as well as his earnings tax (with the working class deduction) to pay for single payer healthcare and a host of other services. This is not him being vague. This is a failure of his critics to pay attention.

If you want to look at a difference in criticism, it's easy to lean on gender here, but you can't exactly discount that Warren's plan is shit, and his works.
posted by kafziel at 11:35 PM on November 3, 2019 [2 favorites]


A flat $9,500/employee tax, and it is a tax, punishes employers who hire working-class employees significantly and specifically, and serves only to depress employment numbers - someone who works 2000 hours at $15/hour costs $30k in wages, but now costs $39.5k to hire.

The tax replaces the employer's requirement to provide health benefits, so it's not some dramatic new tax. Employers in the USA right now pay an average of $14,651 per employee to provide health benefits (not including premiums employees pay themselves). Warren's per-employee tax actually represents a significant savings over private insurance to these employers.

Or worse, since independent contractors specifically do not count as employees for Warren's tally, this will provide a perverse incentive for mass misclassification.

1. This exact same argument was made when Obamacare's small business requirements were introduced and it didn't happen then when it cost more money.

2. Warren's labour plan specifically promises to punish employers who attempt mass misclassification.
posted by mightygodking at 11:47 PM on November 3, 2019 [10 favorites]


If you want to look at a difference in criticism, it's easy to lean on gender here, but you can't exactly discount that Warren's plan is shit, and his works.

Ah, there it is. Citation needed.

Seriously though, AFAIK the Sanders wealth tax is unfortunately not a direct M4A pay-for plan and I believe it doesn't cover the full amount of the cost.

Not to single you out, but comments like these sometimes make me feel some people in the Sanders wing of the progressive movement are more interested in eating themselves than making any sort of unified progress.
posted by donttouchmymustache at 12:03 AM on November 4, 2019 [11 favorites]


David Dayen: Matt Bruenig is mad I won’t call things new when they’re not.
Oh dear.

The debate over Medicare for All financing is stupid. I think everyone involved with it knows it’s stupid. It leads to a narcissism of small differences and pointless fights over things that don’t really need to be fought over.

Matt Bruenig the other day wrote a way to approach Medicare for All financing, where he said you 1) bring in existing health spending, 2) applying cost savings from a universal single payer program, 3) rich people taxes, and 4) employer payments. Elizabeth Warren released a financing plan which included 1) bringing in existing health spending, 2) applying cost savings, 3) rich people taxes, and 4) employer payments. Each have a few more elements, but that’s the bulk of the stuff.

He doesn’t like the employer payment and wants it to be a different employer payment. That’s a valid argument to make, though I don’t think it’s as big a deal as he does (I’ll discuss later). But what he’s really mad about is a headline I wrote suggesting that Warren’s plan doesn’t add any new middle-class taxes. He wants to focus on the word “taxes.” I want to focus on, and have been focusing on, the word “new.” [...]

Now Bruenig thinks he’s caught me in a contradiction by citing a story I wrote describing Bernie Sanders as “replac[ing] insurance premiums and co-pays with middle-class taxes.” Again, the focus of this contradition is on taxes, not the only point I was making, that these are not new. Bernie’s replacement is a tax, in the same way as Warren’s replacement is a tax. But it’s the same bucket of money (actually a tiny bit less in Warren’s case). I just see it as semantic.

I plead guilty to not making that more explicit in the Sanders case; that story  was about the dishonesty of this entire financing conversation. But if you believe that premiums are taxes, I don’t see why you’re so damn concerned about describing something that replaces a premium contribution with a tax contribution as a novel, new thing. [...]

You can criticize Elizabeth Warren for bothering to create a financing plan at all, because this was the inevitable result. The way she talked about it as lowering overall healthcare costs was correct, it’s still correct, and one reason why is that premiums are taxes. The whole discussion is a red herring that has now, helpfully for the Pelosi-Biden axis, set supporters upon one another. Take a bow, everyone.
Scott Lemieux: The Narcissism Of Irrelevant Differences
I mean, here’s the thing: in a wildly optimistic scenario in which Dems do about as well as they can be reasonably hope to do in the 2020 Senate elections and a majority decides to eliminate the filibuster, passing any legislation will require at least two Democratic senators who are refusing to even commit to endorsing the Democratic nominee in 2020. Medicare For All is not going to be passed in the next Congress. Joe Biden’s robust public option, for that matter, is not going to be passed by the next Congress. This is true no matter who becomes president. This is about establishing long-term goals and mobilizing voters — that’s it. So Warren’s plan is fine, Bernie’s plan is fine, and to act as if difference in minor details in them will have policy consequences for the next administration or should influence anybody’s primary vote either way is nuts.
posted by tonycpsu at 9:33 AM on November 4, 2019 [18 favorites]


The Sanders-Warren dispute about how to pay for Medicare-for-all: Bernie’s plan is more technically sound, Warren’s may be an easier sell (Yglesias, Vox)

What's interesting about this article is that someone well to Breunig's left -- indeed, on the centrist side of the writers at the uber-technocratic Vox -- largely seems to agree about the substance of the contrast, though of course he doesn't share Breunig's disdain of the more pragmatic approach Warren takes:
Warren has much more of a reputation as the uber-wonk with plans for everything, while Sanders is seen more as a moralist and a populist who cares less about the technical merits of proposals than whether they illustrate underlying points.

In this particular case, however, that dynamic is reversed. It’s Warren whose plan optimizes for easily illustrating the point that almost everyone’s costs will go down, even at the cost of embracing a vision that’s not going to be technically sustainable for very long. She’s then vague about the timing of the transition off her plan, and is going to transition to something that’s probably a worse deal for many people than a more technocratic alternative would be.

Sanders, by contrast, is proposing a big new broad tax, even though big new broad taxes tend to be unpopular. This is how foreign single-payer systems are typically designed, and it’s almost certainly what a team of policy wonks would recommend if they were setting all political considerations aside.
So on one side we have something that is more progressive and more technically in line both with how other countries do it, and on the other hand we have something this is less progressive but simple and pragmatically easier to sell upfront. Breunig and Yglesias seem to largely agree on the substance here, just not on the relative merits of pragmatism vs progressivism. And presumably they also disagree on whether any of these distinctions truly matter in a world where none of this is likely to pass any time soon.

This brings me to the meta-point, the one that often comes up in center-left vs far-left fights. One side generally contends that the differences, if they exist at all, are meaningless, since the far-left stuff will never pass anyway and thus almost by definition all differences are practically-speaking insignificant. The other side insists that the differences are both morally and practically important, though how the latter works is often vague. I generally can't take the Chapo Trap House guys, but I listened to a brief clip to see how their side is framing this. Substance aside (of course they favor their guy), they had a good meta-point which acknowledged their guy's weaknesses: inasmuch as the two candidates remain indistinguishable policy-wise, they themselves said, there is no reason whatsoever to vote for Sanders over Warren, since she is clearly younger, more charismatic, more pragmatic, less hated by the center-left, etc, etc. So a Sanders supporter needs to highlight policy contrasts, since without that there is nothing. On the one hand that was acknowledging the weaknesses of their guy and their implicit motivation to play up what may be small, or at least non-practical, differences. But on the other hand, the logic currently seems to be that, since all far-left proposals are unlikely, any far-left critique of the center-left is inherently "narcissistic," since it's attacking a fellow member of the left based on pragmatically-irrelevant issues. It would be nice, though, if there could be some sort of framework where we can have a robust intra-left policy debate about these things that allows for contrasts and criticisms which aren't taken as prima facie meaningless or abetting the enemy.
posted by chortly at 11:48 AM on November 4, 2019 [4 favorites]


[Sorry, that first sentence should of course read "well to Bruenig's right..."]
posted by chortly at 12:48 PM on November 4, 2019 [2 favorites]


[Sorry, that first sentence should of course read "well to Bruenig's right..."]

I was gonna say!
posted by Gadarene at 1:06 PM on November 4, 2019


Meanwhile, Nancy Pelosi takes a very disappointing stand against Warren's plan and Medicare for All generally, using her standing as a "left-wing San Francisco liberal" to essentially say that we should never try for anything other than shoring up the ACA, not from a pragmatic standpoint in terms of political feasibility, but because the ACA works better.

Shocked, I am, that an umpteen-millionaire is dismissive of necessary structural change and prefers tinkering with the status quo, but it's genuinely disturbing and makes me pretty pessimistic about even getting buy-in from Democrats on universal health care. Not insurance. Care.
posted by Gadarene at 1:10 PM on November 4, 2019 [8 favorites]


It would be nice, though, if there could be some sort of framework where we can have a robust intra-left policy debate about these things that allows for contrasts and criticisms which aren't taken as prima facie meaningless or abetting the enemy.

In the Sanders/Warren debate over how to pay for their similar health care plans, that debate could take place when the plan, from which ever of them was elected, was presented to congress as they both agree on the importance of the issue and surely wouldn't veto the alternative funding method if that was what was deemed the more likely to pass, but the manner in which we run elections doesn't seem to allow for that kind of agreement between candidates beforehand. They almost have to manufacture differences and emphasize them, no matter how unneeded they might be, just to have something to emphasize as point of contrast. That's not really helpful to the rest of us in the long run, but that's how this system seems to work.

It isn't that there is no difference between the candidates of course, just that the areas of difference between some of them are artificially extended for rhetorical purpose. Unfortunately that can handcuff the winning candidate once they reach office for limiting their negotiating stance in putting forth their agenda, as they've already argued against other possibilities as less workable.

Anyway, I'm more concerned about Buttigieg than the differences between Sanders and Warren, it seems like he's getting more support from the moneyside of the party now that Biden is slipping and I think that would increase dramatically if Biden slips more and Warren or Sanders looks likely to otherwise be the nominee. There are a lot of rich people really worried about a Warren or Sanders presidency, which I suspect Pelosi also well knows.
posted by gusottertrout at 1:30 PM on November 4, 2019


> But on the other hand, the logic currently seems to be that, since all far-left proposals are unlikely, any far-left critique of the center-left is inherently "narcissistic," since it's attacking a fellow member of the left based on pragmatically-irrelevant issues. It would be nice, though, if there could be some sort of framework where we can have a robust intra-left policy debate about these things that allows for contrasts and criticisms which aren't taken as prima facie meaningless or abetting the enemy.

I feel like the absurdly long duration of our presidential campaigns is the primary problem here, or at least a much bigger problem than any single candidate or their supporters. When combined with the tendency of far too many to overvalue the impact of the president as compared to legislators, this results in a permanent siege mentality among factions that agree with each other on a majority of issues, simply because they think the tactically best way to advance toward their common goals involves electing the one individual they've pinned all of their hopes on.

I understand this is a difficult point to make given who's occupying the White House now and how much damage he's been able to do, but I feel like Trump is the exception that proves the rule, because his reign of error has only been possible because of the support he has in the Senate.

If our presidential campaigns were shorter, then there would be more time to articulate major policy differences in ways that wouldn't undermine the goal of getting someone better into the White House. And there'd be more time for the wounds of the bitter primary debates to heal.

Seeing no immediate path toward reducing the length of our campaigns, I kind of feel like the winning move is for the candidates themselves to agree that the differences are small as compared to the importance of universal coverage and cost reduction. Most of this debate seems to be occurring between pundits and not the candidates, so there's still time for this dream to become a reality. But I'd really hate to see them digging in on these very minor details just to differentiate themselves and try to gain an edge.
posted by tonycpsu at 1:39 PM on November 4, 2019 [6 favorites]


Buttigieg does look like the fundraising heir, but doesn't that make him appealing as the winner's VP given his problems with experience, charisma, base demographics and general polling?
posted by Selena777 at 1:40 PM on November 4, 2019


I don't want to derail the thread into Buttigieg territory too far, so I'll just say I still think there's something really extraordinary about his place in this election that really doesn't make sense absent there being some people with pull behind him. I have to think that is because of the deep worry moneyed interests have in a Warren presidency. That part isn't even a secret, it's being reported in different media outlets in ways that feel like a threat. This is one of them from today, where donors are allegedly withholding senate race donations because of Warren.

That kind of stuff matched with things like Zuckerberg shunting tech people towards Buttigieg makes me feel like there's some impending drama to come for Warren, where the quibbling over her funding preference for her health care plan is just a small hint of what's to come and intensify as media companies aren't likely looking forward to a Warren presidency much either.
posted by gusottertrout at 1:52 PM on November 4, 2019 [9 favorites]



I think it’s pretty awful, for the reasons Bruenig outlines in the linked analysis. Additionally, atomizing the workforce as described would have the knock-on effect of hobbling labor solidarity.


Matt Bruening is a faux-left weirdo who is also a big Bernie fan. Not sure why I'm supposed to care about his beliefs given he is not actually on the left and is incredibly biased.

A great example of how not actually left he is is his using right-wing talking points against this plan.
posted by asteria at 9:06 AM on November 6, 2019 [5 favorites]


After Bill Gates complained that he would lose $100B under Warren's plan, she's released a calculator for billionaires.

Spoiler: Bill Gates would pay $6.379 billion a year.
posted by octothorpe at 12:38 PM on November 7, 2019 [8 favorites]


I clicked the “YES” button does that make me a billionaire thanks sen warren bye
posted by Huffy Puffy at 12:48 PM on November 7, 2019 [2 favorites]


Now Bloomberg is apparently getting back in the race.

Although I can't see how adding another "centrist white guy" to the pile is going to _help_ the kind of candidate he wants get elected. I assume this is another case of super-rich guy being surrounded by people who encourage him way too much, as I don't see any scenario where he gets any more traction than Steyer or the other no-hope candidates.

[As long as he sticks to the primary and doesn't do an independent run, this kind of thing seems like it only helps the more-left candidates by splintering the "we want a moderate white guy" vote, although realistically it does neither as Bloomberg will not get any significant support]
posted by thefoxgod at 3:55 PM on November 7, 2019 [1 favorite]


Oh good, another 80 year old white guy running for president. We don't have enough of those.
posted by octothorpe at 4:02 PM on November 7, 2019


Warren’s calculator for billionaires added Mike Bloomberg as an already-calculated option once you click “Yes” to the first question and “Next.” Under her plan, he would pay $3.079 billion in taxes, out of his approx. $52 million.
posted by sallybrown at 5:17 PM on November 7, 2019 [4 favorites]


Eugene Robinson:
It gets even more interesting. I hear from a good source that Eric Holder has been consulting strategists about possibly jumping into the Dem presidential race. NYT reports Michael Bloomberg is seriously considering a late entry as well.
posted by Apocryphon at 8:43 PM on November 7, 2019


After Bill Gates complained that he would lose $100B under Warren's plan...

These guys all want to be history's biggest philanthropists and Warren is going to show them what it really feels like to be sick of winning.
posted by xammerboy at 8:45 PM on November 7, 2019 [1 favorite]


Will Warren's healthcare plan scare off voters in swing states? Let's see what the polls say:

Cook/KFF: Dem swing state polls

PENNSYLVANIA
Biden 27%
Warren 18%
Sanders 14%
Harris 4%

MICHIGAN
Warren 25%
Biden 19%
Sanders 15%
Buttigieg 7%

WISCONSIN
Warren 22%
Biden 17%
Sanders 10%
Buttigieg 6%

MINNESOTA
Warren 25%
Klobuchar 15%
Biden 14%
Sanders 13%
posted by xammerboy at 8:56 PM on November 7, 2019 [5 favorites]


Granted that's primary Democratic voters being polled.
posted by xammerboy at 10:05 PM on November 7, 2019 [2 favorites]




Warren’s calculator for billionaires added Mike Bloomberg as an already-calculated option once you click “Yes” to the first question and “Next.” Under her plan, he would pay $3.079 billion in taxes, out of his approx. $52 million.

52 billion. I went to see how the plan would calculate more tax owed than the dude had, just in case that wasn't a typo.
posted by pwnguin at 3:41 PM on November 10, 2019




Well that's crap
posted by Ray Walston, Luck Dragon at 2:16 PM on November 15, 2019


Why is it crap? Seems like a fairly practical roadmap if a little ambitious.
posted by octothorpe at 4:36 PM on November 15, 2019 [9 favorites]


I think the plan is fine, I just think it was better not to validate the corporate bullcrap wing of the party that's been trying to water down M4A since day one.
posted by Ray Walston, Luck Dragon at 6:53 PM on November 15, 2019


It's typical Warren, focused on nuts and bolts: What she can accomplish through executive action, what will take congress passing legislation and that she thinks is reasonable to expect in the short term, and what will require a larger Democratic majority in Senate and getting rid of the filibuster rule.

She has ambitious goals, but she's not promising to wave a magic wand and make it happen. She lays out step by step what it's going to take to get there.

I really want this woman to be president.
posted by nangar at 7:33 PM on November 15, 2019 [11 favorites]


Psst.. If they believe you'll never be happy, they'll just ignore you, no matter how squeaky a wheel you manage to be
posted by wierdo at 10:15 PM on November 15, 2019 [2 favorites]


I relate to Elizabeth Warren because when I say that I have a plan for that I also mean that I will think about it doing it in three years - @katewillet

Saying that by the end of your third year, you will "fight to" do something is nothing but a setup for "gosh, I tried, but just couldn't!" It's exactly we saw in 2010 - Obama ran on universal healthcare, came in with a supermajority, and handed us the ACA instead.

Sanders is promising to introduce the bill his first week. This is a top priority, not a plan to have a plan.
posted by kafziel at 1:50 PM on November 16, 2019


Does he have a plan on actually getting that bill passed?
posted by octothorpe at 1:53 PM on November 16, 2019 [2 favorites]


Getting anything passed is going to require building a massive movement. In my opinion a president demonstrating that they're willing to fight out of the gate instead of transitioning to "well, maybe we'll start with Medicare for All Who Want It (which if you're going to go through the trouble of fighting the insurance lobby why not just go for the gold in the first place?) and then that will magically become Medicare for All in three or four years" is going to have a much better chance building that movement.

Like, it's going to be a long fight. I don't have any money so the only way I can make any difference is knocking on doors which is terrifying for me, but I've signed up to canvass for the person primarying my district's shitty anti-M4A Dem. It's going to require motivating a lot of people who have never had an interest in politics, and Sanders is going to be much better than Warren at that.
posted by Cezar Golescu at 3:09 PM on November 16, 2019 [2 favorites]


Obama didn’t “come in with a supermajority.” Franken wasn’t seated for months, and Ted Kennedy died a few months later. And that so-called supermajority included senators like Max Baucus (who fought the public option) and the execrable Joe Lieberman (who was the person most responsible for killing the public option and Medicare buy-in for people over 55).
posted by donatella at 3:26 PM on November 16, 2019 [6 favorites]


I think it's disingenuous to describe her 3-year deadline for M4A passage as the starting point of the reform process, or even of the transition. She's clearly saying she'll take action to start transitioning people to a public model on day one. (Heck, even the Sanders plan involves a phased implementation by age.)

If single-payer is as politically risky as polling indicates, it's going to be easier to ease people into it like this instead of trying to do the whole thing in one fell swoop without sufficient popular support. If Obama had tried that same all-or-nothing approach in 2009-10, the ACA would have died in the Senate and we'd have, uh, nothing. There's a reason conservatives have been so adamantly against "giving people a taste" of the benefits of universal healthcare -- they know it builds support for future expansions and makes it much harder to roll back once it's in place. Better to go after the low-hanging fruit first to build a movement toward universal coverage.
posted by Rhaomi at 3:30 PM on November 16, 2019 [4 favorites]


The Senate map is good for Democrats in 2022. In 2020, it's mediocre; with good Democratic turn-out, we have a decent chance of picking up a few seats and winning a narrow majority. This is just because of what seats are up for election and what states they're in. Any major legislative changes in the next presidential term, if they happen, will come after the 2022 midterms. The math and geography of upcoming Senate elections isn't going to change depending on who our nominee is.
posted by nangar at 3:48 PM on November 16, 2019 [5 favorites]


Wow, this is honestly such a good plan to me. It's the details, the evident strategy in stuff like this that makes me believe Warren would be just so much more effective as president than anyone else, to be honest.

So I think there's several dimensions to the strategy here. Feel free to correct me if I'm wrong, but this is my read.

-You pass phase 1 by budget reconciliation after the 2020 election when the terrible senate map (for Democrats) would make it virtually impossible to pass something like M4A.

This element covers all current Medicaid recipients, people under 18, and people 50 and older with the same benefits as the M4A bill describes: complete coverage, dental, vision, etc., no co-pays, premiums, deductibles, etc., right from the start.

You immediately allow everyone else (essentially 18-49 year olds not receiving Medicaid) to opt into an Medicare-type public insurance "plan", zero deductible, for free for those with an income of up to 200% of the federal poverty line, and then for incomes above that, with a progressive premium schedule capped at 5% of income at the highest tier. The plans cover 90% of costs, with caps on out-of-pocket costs (ostensibly similar to Medicare) and include provisions to decrease the cost-sharing down to zero in 3 years' time.

-In the interim, you pursue all the details. You start with anti-corruption, anti-lobbying, anti-corporate influence legislation, etc. on the side of gov't influence. You pursue standardization of healthcare forms and records, intervention in pharma markets to eliminate price gouging (by essentially allowing for the production of generics by the government), reverse the GOP sabotage under the current administration, strengthen and streamline ACA (mandating comprehensive coverage and banning junk health plans outright), enforce anti-trust in healthcare, etc., basically everything that needs to be in place to allow M4A to be cost-effective. All of this would serve to completely change the political environment and the concept of health insurance by the 2022 midterm elections.

-After the 2022 election when the more favorable Democratic senate map has resulted in a greater senate majority, and after most people in the U.S. are likely covered by a phase 1 "plan", phase 2 can be passed. This would essentially be a mandate of true and complete M4A for everyone who was not covered in phase 1.


If phase 1 is passed first, why would there be political capital in 2023 allow for phase 2 to be passed as well?

Because by this time, most people will be enrolled in the public plan. Much of the health insurance industry would have transformed and moved on to other insurance markets (plastic surgery insurance? other fringe care insurance?) due to an inability to compete, and the cost-sharing noted above would have rolled down to zero. This removes practically all barriers, political and otherwise, that would prevent congress from voting for M4A. Furthermore, the reforms passed in the interim would make congress not beholden to wealthy donors, lobbyists, and corporate interests. In addition (and notably unlike Sanders at the moment), if the filibuster proves to be an impediment to the above, Warren has said she would get rid of the filibuster in order to pass it.

How can you sell this politically?

For the progressive left: First of all, this is absolutely real M4A, all coverage, benefits are exactly as detailed in the Sanders M4A bill that Warren co-sponsored. The anti-corruption reforms and healthcare reforms (e.g. the gov't can manufacture generic drugs to reduce costs for essential medication) are completely in line with current progressive platform and ideas. In fact, Warren's plan would get us to full M4A by year 3, whereas Sanders gets us there in 4 (but his campaign hasn't provided the details on how this could get done politically, etc.), making this is the quickest-to-M4A plan yet by any candidate.

For the moderate-middle: The candidates who have said they would want M4A-like single-payer eventually but just not from the start have not provided many details as to how they would fund their initial plans and how they plan to get to M4A eventually. This makes some people concerned that they might "quit early" (e.g. at a restored ACA with a public option). Considering the level of influence of the healthcare industry on our government, those people might be right. Warren here has done their homework for them, showing how you can get from here to M4A from a political standpoint, and in how long (and how to pay for it).

For the moderate-centrists: Healthcare costs are growing faster in the U.S. than in any other developed economy. Health-related expenses are the number one reason American families go bankrupt today. If you don't really see the ethical and moral implications of this, gone unchecked, this will certainly have a terrible effect on the U.S. economy going forward. The fastest way to bring those costs down is with a single-payer system (because of centralized bargaining power, etc.), the same way many other developed economies have opted for. It's expensive, but this is how we pay for it with the smallest effect on the U.S. economy. It's also complicated to get there from our current system, but we can achieve it in 3 years' time in 2 phases.

For the cynics: Yes, we know, anything can happen to the best-laid plans. But this blueprint is the closest we have ever been to single-payer in this country. We can do this.
posted by donttouchmymustache at 2:32 AM on November 17, 2019 [12 favorites]


-After the 2022 election when the more favorable Democratic senate map has resulted in a greater senate majority, and after most people in the U.S. are likely covered by a phase 1 "plan", phase 2 can be passed. This would essentially be a mandate of true and complete M4A for everyone who was not covered in phase 1.

The one major pragmatic problem I see here is that one of the most iron-clad rules in US electoral politics of the last 50 years is that the party of the president always loses seats in House and Senate in their first midterm. (2002, after 9/11, is the exception that really proves the rule.) Bucking this pattern would require something almost as historically unprecedented as passing M4A outright in the first two years.
posted by chortly at 12:36 PM on November 17, 2019


I completely understand that concern.

However the way I see it, the fact is that by that point people will already be either on M4A-as-defined (the under 18s and over 49s), and that most of the rest of the population will be on the public transition plan, which if you remember at this point would have reduced the cost-sharing down to zero, means that phase 2 would be a completely different "sell" in 2023. This is what I meant by the built-in 'evident strategy' in Warren's plans.

Not to mention the lobbying and anti-corruption reforms (even the small stuff like prohibiting elected officials from owning individual stock in companies) would have an immediate effect on political campaigns and campaign contributions (politicians will have to increasingly rely on grassroots support). Politicians' platforms in 2022 would look very different because they'd have to be in order to remain viable.

But if you couldn't already tell, I'm obviously biased. (Another thing I like about Warren's plans is how they're all interconnected like this, and implementing one makes the others both easier to implement and more essential.)
posted by donttouchmymustache at 1:09 PM on November 17, 2019 [2 favorites]


I think all that is probably true, but it doesn't change the fact that no matter how much the landscape changes, I don't think anyone thinks anything will pass with a single Republican vote. So losing either the House or Senate means it all stops dead. And the president's party has always lost one or both in the first midterm. But I honestly don't know what is more unlikely -- persuading Manchin to vote for M4A outright in 2021, or holding the House and Senate through the midterm and persuading Manchin to vote for phase 1 on 2021 and then for phase 2 in 2023.
posted by chortly at 1:16 PM on November 17, 2019


Good question. This is all beyond hypothetical at this point, but I do think passing an all-in-one M4A bill in 2021 would be a challenge, and not only because of Manchin. I have a feeling it'll likely hinge on convincing closer to 5 to 10 Democratic senators (at the very least) to vote for any kind of healthcare reform bill which ends private insurance outright. Introducing phase 1 like a sort of Medicare expansion might be an easier sell in 2021, and by 2023 you'll simply be asking senators to vote on mandating universal coverage for the remaining population and the final bits and pieces.

I think Manchin might find that easier to swallow by 2023, especially in an environment where he'll no longer have any reason to be concerned about his specific investments.
posted by donttouchmymustache at 3:28 PM on November 17, 2019


Either you assume that a Democratic president will be able to pass bills at all 2021-2022, which requires either a majority Senate and a dead filibuster or a supermajority Senate, or you assume that they can't. If they can, that bill should be full M4A. If they can't, they should be fighting Republicans about full M4A, making the fight about full M4A, and attacking them district by district, state by state - and eagerly primarying Democrats who do not fall in line. All of those are things Sanders has vowed to do, making single payer health care his first and top priority, and are supported by his actions over the last four years, building public support and bolstering primary campaigns against shitty right wing Dems. You fight for the goal, not for a pre-compromised nothing that still won't work.

Warren's plan is the same as Buttigieg's. It's nothing.

If single-payer is as politically risky as polling indicates

This is a right-wing talking point, pushed by the insurance industry. Single payer is polling at 70% national support, 85% among Democrats, and that's with the conservative bias of polling methods. It's not "risky". "Risky" is doing anything else.
posted by kafziel at 4:35 PM on November 17, 2019 [9 favorites]


Ridiculous hyperbole helps nobody.
posted by wierdo at 4:39 PM on November 17, 2019 [6 favorites]


I think the way Warren rolled out her health care proposals was well thought-out, and getting attacked from the right and the left this way has shifted the conversation the way she wanted. Now Democrats are mostly arguing about how to pay for single-payer and the best way to implement it, not whether we should do it or not. Democrats who are flat-out opposed to the idea end up looking left out. She didn't play to the center the way pundits would advise, she's shifted the center of the debate to close to where she is.

Of course, she's taken a hit in polling while doing this, mostly to the benefit of Sanders and Buttigieg. Will this be temporary? I don't know. But the strategy seems to be working, and I think it will pay off in the long term.
posted by nangar at 7:04 AM on November 18, 2019 [3 favorites]


NYT article on how Elizabeth Warren got to "Yes" on Medicare for All. Bylines: Shane Goldmacher, Sarah Kliff (formerly did Vox healthcare stories) and Thomas Kaplan; I don't know why he doesn't have a byline, but "Jonathan Martin contributed reporting."

What few people knew then was that Ms. Warren and her Boston-based team had been privately crunching numbers since at least late August, working with the internal imperative to craft a package without hiking middle-class taxes, according to interviews with people directly involved in the process.
posted by toastyk at 9:05 AM on November 18, 2019 [3 favorites]


This is a right-wing talking point, pushed by the insurance industry. Single payer is polling at 70% national support, 85% among Democrats, and that's with the conservative bias of polling methods. It's not "risky". "Risky" is doing anything else.

A public option has high support. Single payer does not (yet).
Whether you love, hate or are indifferent toward his “Medicare for All” plan, polls show Sanders leading when Democratic voters are asked which candidate they think is best able handle to health care.

The thing is, though — according to new polling from Marist College this week — Sanders’s plan isn’t actually the most popular idea in the field. Instead, that distinction belongs to what Marist calls “Medicare for all that want it,” or what’s sometimes called a public option — something very similar to Joe Biden’s recently unveiled health care plan, which claims to give almost everyone “the choice to purchase a public health insurance option like Medicare.”
I personally think M4A would be great. But that doesn't mean that the electorate is on board with it.
posted by Jpfed at 11:41 AM on November 18, 2019 [2 favorites]


Either you assume that a Democratic president will be able to pass bills at all 2021-2022, which requires either a majority Senate and a dead filibuster or a supermajority Senate, or you assume that they can't

This does not make sense. Remember the ACA.

Let's say there are 50-52 Dem Senators (this is an optimistic case IMO) and a nice House majority (much more likely). At that point, 1-3 defections on the Senate are all thats needed to kill a bill.

Thats a scenario where the President can maybe get one big thing passed (through reconciliation) or a few things if they kill the filibuster.

But getting 100% of Senators to agree on a bill as transformative as M4A, when they couldn't get all the Democrats to agree on the ACA, seems extremely unlikely. Manchin / Sinema / Tester / Jones (in any optimistic scenario I think Jones had to win AL again) / etc are quite likely to defect. Most of those are on record (Sinema, Tester, etc) as saying they wont vote to end the filibuster either.

It's not a parliamentary-type system where the party votes in lockstep, even for the Republicans (remember we only have whats left of the ACA because McCain, Collins, and Murkowski defected).
posted by thefoxgod at 1:53 PM on November 18, 2019


She appears to be trying to do phase 1 (Big Public Option) through reconciliation in year 1. That’d be a doozy if she could do it, and she only needs a majority in the Senate, and she doesn’t have to blow up the filibuster to do it.

Full single payer, they’re going to have to eliminate the filibuster to pass. Which she’s said repeatedly she wants to do, but which would probably require a different batch of senators to achieve.

But if you can get a good public option through reconciliation, that’s a huge leap forward. It’s not all the way, but it’s still really good.
posted by Huffy Puffy at 2:05 PM on November 18, 2019 [5 favorites]


Warren and Sanders seem to have the same desired end state, but Warren refuses to allow the perfect to be the enemy of the good, or to allow the contradictions to be heightened on the backs of sick and dying Americans while amassing the requisite political power to bring about that desired end state. Honestly, I don't think Sanders would turn down a strong public option if it were on the table, either. He's not a monster, and he'd want to bank a win. But getting to the point where he would be in a position to do so requires pretending otherwise.
posted by tonycpsu at 2:32 PM on November 18, 2019 [8 favorites]


It's politics, if you want x ask for 1000x. If you want a strong public option fight like hell for full single payer and settle for the public option.
posted by Cezar Golescu at 2:36 PM on November 18, 2019 [1 favorite]


Wall Street Doesn’t Believe Elizabeth Warren Is Serious About Medicare for All
People on the Left have been debating Elizabeth Warren’s health plan since it was released a couple of weeks ago — “realistic” or a ruse? I vote ruse, but I don’t want to make that argument myself right now. Instead, I’ll allow a research note from Barclays, which found its way into my inbox, do that work.

Here’s the opening paragraph of the report, by Barclays analyst Steven Valiquette:

"Compared to her previous hardline stance on M4A, the new plan represents a significant change in tone, in our view. Not only does the transition plan push out the legislative agenda for M4A (potentially to year 3), but it also tacitly acknowledges the practical and political resistance of pushing too much change too quickly. In fact, we think Warren’s plan was carefully crafted to appease both progressive and moderate Democrats, and may afford her flexibility to pivot on health care issues throughout the Democratic primaries. All said, her near-term plan seems much closer to more moderate proposals endorsed by Biden and Buttigieg; and as such the “pivot” catalyzed HC [health care] Services stocks on Fri with MCOs [managed care organizations] leading the way (+5% vs S&P 500 up 0.8%)."

Health-care stocks rallied on the release of Warren’s plan, meaning that Wall Street — which isn’t always right, but does have some skill in decoding political bullshit — sees her plan as political bullshit.
posted by Cezar Golescu at 4:31 PM on November 18, 2019


Well, I guess that settles it, what with Wall Street's flawless record of accurately assessing risk.
posted by tonycpsu at 5:35 PM on November 18, 2019 [9 favorites]


Wall Street Doesn’t Believe Elizabeth Warren Is Serious About Medicare for All

See, it's articles like this one that seem funny to me. If you look anywhere else, almost across the board on every other publication, CNBC and WSJ, NYT and WaPo, interviews and op-eds, comments from "Wall Street Democrats", and "sources close to" Bloomberg's and Patrick's campaigns, you might just believe they're taking her progressive platform very seriously. Why her approach to M4A would be any different, well maybe you'd need an insider at Jacobin to tell you that.

I can't say I'm surprised though. Ever since Warren's emergence in the top tier of candidates, I have yet to see a Jacobin article about Warren that didn't seem like a carefully crafted attempt to drive her progressive support down. Although in all honesty, a publication being unafraid to display their political bias could be seen as a virtue, particularly in these times.
posted by donttouchmymustache at 9:37 PM on November 18, 2019 [1 favorite]


The old saw about weathermen is far more accurately applied to Wall Street "analysts," and doubly so if you're reading what they claim to be their current thinking. The people who can accurately gauge the market are busy making money, whether by selling their analysis at a substantial cost or by trading themselves.

They sure as shit aren't telling every Tom, Dick, and Harriet anything until it doesn't matter any more.
posted by wierdo at 10:03 PM on November 18, 2019 [1 favorite]


Wall Street Doesn’t Believe Elizabeth Warren Is Serious About Medicare for All


Jacobin has turned into a self-parody of itself. Someone should create a Jacobin Pitchbot account on Twitter if they haven't already.
posted by octothorpe at 4:34 AM on November 19, 2019 [2 favorites]


[One deleted. Let's please try to avoid the "briar patch" or similar Br'er Rabbit/Uncle Remus references that some of our members have pointed out are grounded in racist stereotypes. Thank you!]
posted by taz (staff) at 6:48 AM on November 19, 2019


Jacobin has turned into a self-parody of itself.

This has always been the space they've staked out though, and it's part of their value. It's very deliberately a hard left journal with strong political and production standards. They're going to be against anyone to the left of Sanders. There's a million other places for nuance and realism.

(Now anyway, if you want Jacobin self-parody, read anything ever written in it about pop culture. My god the douche chills it brings on.)
posted by Lentrohamsanin at 7:13 AM on November 19, 2019 [1 favorite]


While Bernie voters most often have Biden as their #2 choice, that is likely not the case among Jacobin readers- who are likely more ideologically consistent than that. It makes perfect sense for them to attack Warren as a way of solidifying support for Bernie among their readers.
posted by Jpfed at 7:40 AM on November 19, 2019 [1 favorite]


Warren is Doing Great
She's doing so well that today the Times has chosen to feature on their web front page (1) an op-ed entitled "The Danger of Elizabeth Warren," (2) a fawning puff piece about Joe Biden, and (3) an equally fawning puff piece about Nikki Haley.

Keep it up, Senator Warren. You're scaring exactly the right people.
The Times is in full on panic mode at this point.
posted by tonycpsu at 10:00 AM on November 20, 2019 [5 favorites]


New Warren ad: I think she will be an amazing president.
posted by octothorpe at 10:10 AM on November 20, 2019 [5 favorites]


I wonder what happened in the last couple weeks to make Barkan change his tune so dramatically on M4A.
posted by Cezar Golescu at 12:09 PM on November 20, 2019


For some people, there's a giant difference between Bernie's plan and Warren's. But what constitutes a giant difference is a matter of perspective. It's possible that Barkan doesn't see himself as having changed tunes dramatically at all. From some perspectives, Bernie's and Warren's plans are very similar (e.g. people that complain that Warren copied Bernie's plan give some evidence that they believe the plans are similar).

(I also think that some people not appreciating these differences in perspective may partially explain why they reply to Barkan indicating a sense of betrayal, or questioning whether he is still in full possession of his faculties or twitter account.)
posted by Jpfed at 12:35 PM on November 20, 2019


I just think it's strange to go from:
One of the questions I most wanted Barkan to answer was on the public option, which is quickly becoming the Sensible Beltway Alternative to single-payer, and why he supports Medicare for All instead. Barkan wasn’t always a Medicare for All activist. In the past, he said, he “probably agreed with people who thought a policy that ambitious just wasn’t gonna happen.” Now, however, he said that he “truly believes it’s the only way forward.” To the argument that a public option would be easier to pass, he pointed to the power of insurance and pharmaceutical companies: “It’s not like the powerful industries will just let a public option slide through, so either one will be a fight.” If we are to defeat this power, he said, we need “a truly enormous grassroots movement, and that only exists for Medicare for All. No one is gonna get arrested for the Public Option Choice Act of 2021.”
...to endorsing the candidate whose big plan is basically the Public Option Choice Act of 2021.
posted by Cezar Golescu at 12:53 PM on November 20, 2019 [1 favorite]


Rolling out a supercharged public option (among other reforms) to build the support needed to expand to full M4A within her first term is not the same thing as a plan for a public option only.
posted by Rhaomi at 1:58 PM on November 20, 2019 [6 favorites]


But it will require having to pass a bill an extremely powerful lobby opposes once instead of twice. Her plan is literally "Medicare for All Who Want It, and it will be so great everyone who doesn't want it will now want it." I remember the aftermath of the ACA, this plan just seems unrealistic to say the least.
posted by Cezar Golescu at 6:56 PM on November 20, 2019


Er, should say "twice instead of once."
posted by Cezar Golescu at 7:47 PM on November 20, 2019


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