MEDICARE FOR ALL: ONE WAY TO PAY FOR IT

The main critique of Medicare for All has been that it’s too expensive and that we can’t afford it. Or that the only way to pay for it would be a big tax increase on the middle class. My previous post discussed the big picture in the health care debate – should comprehensive health care be available and affordable for everyone or should it be left to the private market where people buy whatever they can afford. It also documented the consensus that Medicare for All would provide significant savings and reviewed the typically ignored costs of not having universal, comprehensive health care.

To counter criticism that Medicare for All is unaffordable, Senator Warren recently released a detailed proposal for how she would pay for Medicare for All and its estimated cost of $59 trillion over ten years. She identifies $7.5 trillion in savings to offset part of the cost and then identifies $52 trillion in revenue to pay for the remaining costs. The revenue would come from the following: [1] [2]

• $31 trillion that is already being paid by the federal, state, and local governments for health care.
• $9 trillion from a fee that employers would pay per employee instead of paying for a portion of employees’ health insurance. This is projected to SAVE employers $200 billion over ten years.
• $3 trillion from a 3% annual tax on individuals’ wealth of over $1 billion and the annual collection of a tax on the increase in the value of investments (i.e., a capital gains tax).
• $2.9 trillion from closing corporate tax loopholes on the earnings of multinational corporations and from reducing accelerated write-offs of equipment purchases.
• $2.3 trillion from improved enforcement of existing tax laws by enhancing the IRS’s enforcement capacity and effectiveness.
• $1.4 trillion from increased income taxes paid on the roughly $4 trillion increase in workers’ take-home pay because they would no longer have money deducted from their paychecks for the health insurance premiums of their employers’ health plan or for health savings accounts.
• $900 billion from a financial transaction tax of 0.1% on sales of stocks, bonds, and other financial instruments (that’s a sales tax of $1 on every $1,000) and a fee on too-big-too-fail banks to reflect the risk they present to our economy.
• $800 billion from eliminating the Defense Department’s Overseas Contingency Operations fund, which is basically a slush fund for military spending that was originally meant to be short-term funding for unanticipated expenses of wars in the Middle East.
• $400 billion from immigration reform that allows undocumented workers to work legally and therefore pay taxes on their earnings.

Warren’s plan projects that over ten years about $11 trillion would go back into people’s pockets because they would no longer be paying the $20,000 per year the average family pays for private insurance premiums, co-pays, and deductibles. If insurance premiums are viewed as a mandatory expense that is essentially a tax, this would represent the largest tax cut in American history for low and middle-income households. [3]

The Warren plan projects savings of $7.5 trillion over ten years from:

• Reducing payments to service providers to save $2.9 trillion.
• Cutting administrative spending by $1.8 trillion, reducing it from the current 12% of private insurers’ premiums to 2.3%, which is what Medicare spends on administrative costs.
• Saving $1.7 trillion on drug prices by negotiating prices and setting a price ceiling for each drug that is 110% of an international index. If a drug company won’t negotiate a price under that ceiling, the plan calls for revoking the drug’s patent and licensing other manufacturers to make the drug or having the government manufacture it directly.
• Restraining the growth in health care costs to the rate of growth of the economy to save $1.1 trillion, setting an overall health care budget cap, if necessary.

These projected savings do not include likely savings from the benefits of broad implementation of preventive care or stronger enforcement of antitrust laws. Virtually every part of our health care system has become highly concentrated, which increases costs due to monopolistic power. For example, hospitals in 90% of metropolitan markets are highly concentrated due to the 1,667 hospital mergers that have occurred over the past 20 years.

Now that Sen. Warren has put out a detail proposal for paying for Medicare for All, opponents of Medicare for All will quibble over the specific estimates and whether these revenue sources are the best way to pay for Medicare for All. They may also shift their criticism to other aspects of the transition to Medicare for All. The transition will be complex because Medicare for All is a major restructuring of our health insurance system.

Warren proposes a four-year transition period in two steps. First, soon after she becomes President, everyone would be allowed to buy into Medicare and it would be free for anyone under 18 or with an income below twice the poverty line (about $51,000 for a family of four). Second, three years later, Warren would push legislation that would complete the transition to Medicare for All and eliminate private insurance except for very special situations. [4]

The bottom line is clear: Medicare for All can be paid for, it will lead to significant savings in health care, and most Americans will be better off both health care-wise and financially. Everyone who’s honestly analyzed Medicare for All acknowledges that there will be significant savings from reduced administrative and non-care overhead costs, as well as from cost controls and long-term health benefits due to increased preventive care and reduced barriers to accessing care when needed. As Dr. Donald Berwick, the former administrator of Medicare and Medicaid has said, based on his extensive experience, only a single-payer system can both improve quality and control costs.

Therefore, Medicare for All is a realistic policy option. After all, all the other developed countries in the world have some version of a national health care system that covers everyone, controls costs, and enhances quality. We can do this too!

Medicare for All will improve access to care for many Americans, reduce costs for almost all Americans, and increase people’s choices of doctors, hospitals, and other providers for everyone who now faces restrictions from their private insurers.

My next post will summarize the reasons why a single payer system is necessary for efficiency and quality, and why having a private insurer option undermines the overall health care system.

[1]      Warren, E., 11/1/19, “Ending the stranglehold of health care costs on American families,” Team Warren (https://medium.com/@teamwarren/ending-the-stranglehold-of-health-care-costs-on-american-families-bf8286b13086)

[2]      Dayen, D., 11/1/19, “Warren’s Medicare for All plan includes no new taxes on the middle class,” The American Prospect (https://prospect.org/health/warrens-medicare-for-all-plan-includes-no-new-taxes-on-the-middle-class/)

[3]      Dayen, D., 10/22/19, “The Medicare for All cost debate is extremely dishonest,” The American Prospect (https://prospect.org/politics/medicare-for-all-cost-debate-is-extremely-dishonest/)

[4]      Bidgood, J., 11/16/19, “Warren outlines phased path to Medicare goal,” The Boston Globe