MEDICARE FOR ALL. “Midway through July’s interminable Democratic debate, Senator Elizabeth Warren asked a simple question. “I don’t understand why anybody goes to all the trouble of running for president of the United States just to talk about what we really can’t do and shouldn’t fight for,”..“I don’t get it.” (A)

ASSIGNMENT: After scanning From REPEAL & REPLACE to WRECK & REJOICE (from Obamacare to Trumpcare) http://doctordidyouwashyourhands.com/2018/04/from-repeal-replace-to-wreck-rejoice-from-obamacare-to-trumpcare/ , start tracking Medicare for All.

“On March 24th, 2017. “Speaker Paul Ryan (R-Wis.) on Friday said his party “came up short” in a news conference minutes after pulling the GOP healthcare bill off the House floor, acknowledging that ObamaCare will stay in place “for the foreseeable future.””

Yet on December 20th, 2017 the INDIVIDUAL MANDARE was repealed. ““When the individual mandate is being repealed that means ObamaCare is being repealed,” Trump said…“We have essentially repealed ObamaCare, and we will come up with something much better…””

At the end of this post there are links to a series of over 60 posts tracking the activity between March 24th and December 20th. Laws are like sausages,” goes the famous quote often attributed to the Prussian Chancellor Otto von Bismarck, “it is better not to see them being made.”

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“Senator Elizabeth Warren on Friday revealed her plan to pay for an expansive transformation of the nation’s health care system, proposing huge tax increases on businesses and wealthy Americans to help cover $20.5 trillion in new federal spending…

Under Ms. Warren’s plan, private health insurance — which now covers most of the population — would be eliminated and replaced by free government health coverage for all Americans. That is a fundamental shift from a market-driven system that has defined health care in the United States for decades but produced vast inequities in quality, service and cost…

Like Mr. Sanders, Ms. Warren would essentially eliminate medical costs for individuals, including premiums, deductibles and other out-of-pocket expenses. But it is not clear if her plan would cover the costs of free health care for everyone. It relies on ambitious assumptions about how much it can lower payments to hospitals, doctors and pharmaceutical companies, and how cheaply such a large system could be run.” (B)

“Warren’s plan estimates that total health costs could be held to $52 trillion and that $20.5 trillion in new federal spending would be necessary…

Where the $20.5 trillion comes from:

Employers are one of the main sources of revenue in this proposal. Warren says she would raise nearly $9 trillion here, a figure that comes from the roughly $9 trillion private employers are projected to spend over the next decade on health insurance. The idea here is that instead of contributing to employees’ health insurance, employers would pay virtually all of that money to the government.

In addition, she will boost her proposed 3% wealth tax on people with over a billion dollars to 6% and also boost taxes on large corporations. Altogether, she believes, taxes on the rich and on corporations would raise an estimated $6 trillion. An additional $2.3 trillion would come from improving tax enforcement.

But there are lingering questions about how much revenue some of these taxes would bring in or how easy it would be to impose a wealth tax in particular.

“Something like half of the wealth of the wealthiest people in America are held in privately held corporations, privately held businesses,” said Howard Gleckman, senior fellow at the Urban-Brookings Tax Policy Center. “And it’s really hard to value those assets for tax purposes.”

Warren also includes comprehensive immigration reform as part of her plan. Giving more people a path to citizenship would mean more taxpayers, which would mean more tax revenue.

While Medicare for All is Sanders’ plan, his bill does not include set methods to pay for the plan. Rather, Sanders has included “options” to pay for his health care plan. In a recent interview with CNBC, he said “we’ll have that debate” over how exactly to finance the plan.” (C)

“Here’s a summary of what Ms. Warren has proposed on either side of the ledger.

To reduce the plan’s costs:

Change the way Medicare pays for certain types of hospital stays, such as paying a package rate rather than different fees for surgical services, and paying doctors in hospital-owned practices the lower prices paid to those in private practices. ($2.3 trillion)

Assume that the Medicare for all program itself can operate very leanly. The Urban Institute estimated that Medicare would devote about 6 percent of its health budget on administrators to decide what and how Medicare would pay for things, and to prevent fraud. In Ms. Warren’s plan, that rate is 2.3 percent. ($1.8 trillion)

Assume very aggressive drug discounts. Ms. Warren believes a government system will be able to reduce spending on drugs substantially, including lowering the prices of branded prescription drugs by 70 percent. ($1.7 trillion)

Assume slower growth in health spending over time. The federal government now thinks health spending will increase by 5.5 percent a year; the Warren campaign assumes 3.9 percent growth under Medicare for all, closer to the rate of growth in gross domestic product. ($1.1 trillion)

Assume lower payments to hospitals. The campaign believes hospitals can be paid around 110 percent of what they are currently paid by Medicare, a number that would cause some hospitals to operate at a loss. Currently, private health insurers often pay a lot more to hospitals than Medicare for similar procedures. ($600 billion)

What Warren Proposes

“Medicare for all” would shift a huge amount of health care money to the federal budget, increasing federal spending by $34 trillion over a decade, according to the Urban Institute. Here’s how Elizabeth Warren would make the math work.

To pay for the plan:

Employers would be required to pay fees to the federal government, equivalent to 98 percent of what they now spend on their employees’ health care. Some companies would be exempt, and companies with unionized work forces would be able to lower this payment if they increased workers’ wages. Currently, companies vary greatly in the cost and generosity of their health benefits, so this fee would vary substantially by firm. ($8.8 trillion)

States and local governments would be required to make payments to the federal government, similar to what they currently spend on government employee benefits and their share of Medicaid expenses. ($6.1 trillion)

Corporate taxation would be increased. ($2.9 trillion)

Tax collections would increase through improvements to I.R.S. enforcement, which Ms. Warren believes could raise a lot of money. ($2.3 trillion)

The top 1 percent of individual earners would pay new taxes on their capital gains; they would pay taxes on increases in investment value annually, instead of waiting until assets are sold. ($2 trillion)

Income tax collections would increase, since workers would no longer pay part of their salaries for insurance premiums, which are not taxed now. ($1.4 trillion)

Billionaires would pay a higher wealth tax than the rate Ms. Warren has previously proposed: 6 percent, up from 3 percent. ($1 trillion)

A new financial transactions tax would be imposed on stock trades. ($800 billion)

Pentagon spending from an overseas contingency fund, often criticized as a slush fund, would be eliminated. ($800 billion)

Income earned by immigrants, following the passage of her immigration overhaul plan, would provide new tax revenues. ($400 billion)

A risk fee on the liabilities of banks with more than $50 billion in assets would be introduced. ($100 billion)” (D)

“Displaying a new assertiveness toward her Democratic opponents, Elizabeth Warren laced into her chief political rivals, warning on Friday night that the country was in a “time of crisis” and arguing that Democrats would lose in 2020 if they nominated “anyone who comes on this stage and tells you they can make change without a fight.”

Speaking to thunderous applause during the party’s biggest Iowa political event of the year, Ms. Warren denounced candidates in the presidential race who opposed bold ideas in favor of more moderate solutions, in veiled attacks on Joseph R. Biden Jr. and Pete Buttigieg.

“Fear and complacency does not win elections,” she said at the Iowa Democratic Party’s fund-raising dinner. “Hope and courage wins elections. I’m not running some consultant-driven campaign with some vague ideas that are designed not to offend anyone.”..

 “We need big ideas, and here’s the critical part: We need to be willing to fight for them,” Ms. Warren said. “It’s easy to give up on a big idea, but when we give up on big ideas, we give up on the people whose lives would be touched by those ideas.”” (E)

“How does the Warren plan expand Medicare to cover everyone without raising taxes on the middle class? There are four main components.

First, the Warren team argues that a single-payer system would provide significant savings in overall medical costs — more than other studies are assuming. Some of these would come from bargaining down prices, especially on drugs. Others would come from a reduction in administrative costs.

Are these savings plausible? Well, America does pay incredibly high prices for drugs compared with other countries, and the complexity of our system imposes a huge administrative burden — not just the overhead of insurance companies, but the sheer number of people doctors and hospitals have to employ to deal with multiple insurers. I’ve been puzzled at the reluctance of other studies to credit Medicare for all with big savings on these fronts.

And we should note that even with these assumed cost savings, U.S. health spending per capita would remain far above that of other advanced countries. So there’s a case — not an open-and-shut case, but a reasonable one — for optimism here.

Second — and the cleverest item in the plan — the Warren team would basically require employers who are now offering health insurance to their employees to pay the cost of that insurance to the government instead. Bear in mind that large employers are already required by law (specifically, the Affordable Care Act) to provide insurance. So this would just redirect those funds.

Third, state and local governments currently spend a lot on health care, mainly but not only through their share of Medicaid spending. The Warren plan would require “maintenance of effort,” basically requiring that states continue to spend that money, but on supporting a national plan.

Finally, even with all this there’s a significant budget hole. Warren’s team argues that this can be closed in two ways: some further taxes on corporations and large fortunes, and — an important point — strengthening the I.R.S., which we know fails to collect large amounts of legally owed taxes, principally from people with high incomes, because Republicans have starved the agency of resources.” (F)

“Whatever their many flaws, Medicare for All advocates used to have a decent answer to the question of how they’d pay for it. Taxes would go up, they’d admit, but these taxes would be de facto premiums, because they’d replace the money Americans already spend on premiums and other health costs. On top of that, the taxes would be progressive, increasing with income, unlike normal premiums — and aggressive price controls would reduce costs overall.

I mean, good luck with that, both politically and practically. But you can’t deny that there’s a logic to it.

For whatever reason, though, Elizabeth Warren today opted for a different approach: one where premiums go away, middle-class taxes don’t go up (not even a penny!), and taxes on the rich make up the difference. In other words, it’s a system where everyone else gets their health care at the expense of the wealthy. Even if that sounds appealing, her plan for doing this shows how silly it is.

First, the plan doesn’t keep its promise. Nearly half the funds come from redirecting the money that employers spend on health benefits to the government. Sorry, but your health benefits are part of your compensation. Sending that money to the state instead is a tax on you, not your employer.

And second, in trying to force rich people to pay for (much of the other half of) everyone’s health care, the plan basically blows every dollar the government could hope to collect from the wealthy in the coming years. The corporate tax goes back up to the uncompetitive 35 percent rate it was before the tax reform, and would be collected far more aggressively too. (Part of the burden of the corporate tax is borne by workers, by the way.) Warren’s wealth tax for “ultra-millionaires” gets a new 6 percent annual rate for those with more than $1 billion.

We already have a ton of debt and frightening obligations to provide old-age entitlements to hordes of retiring Baby Boomers, and yet this plan would eat up trillions in new revenue sticking the rich with the health-care bills of middle-class Americans who say they like their current insurance…

The easy solution is just to go back to the old argument, where taxes do go up but they’re more progressive than premiums and lower on average. But maybe middle-class Americans won’t want to give up their health insurance unless you bribe them with buckets of rich-people money.” (G)

“Senator Elizabeth Warren vowed on Friday to pass major health care legislation in her first 100 days as president, unveiling a new, detailed plan to significantly expand public health insurance coverage as a first step, and promising to pass a “Medicare for all” system by the end of her third year in office that would cover all Americans.

The initial bill she would seek to pass if elected would be a step short of the broader Medicare for all plan she has championed. But it would substantially expand the reach and generosity of public health insurance, creating a government plan that would offer free coverage to all American children and people earning less than double the federal poverty rate, or about $50,000 for a family of four, and that could be purchased by other Americans who want it…

But under the plan she presented on Friday, she would not seek passage of a single-payer system early in her presidency. The proposal would instead move people into that system gradually — in a way she hopes would build public support for full-fledged Medicare for all — while temporarily preserving the employer-based insurance system that covers most working-age adults today.

“I believe the next president must do everything she can within one presidential term to complete the transition to Medicare for all,” Ms. Warren, of Massachusetts, wrote in her plan. “My plan will reduce the financial and political power of the insurance companies — as well as their ability to frighten the American people — by implementing reforms immediately and demonstrating at each phase that true Medicare for all coverage is better than their private options. I believe this approach gives us our best chance to succeed.”..

With her interim plan, Ms. Warren is attempting to offer something attractive to both sides of the Democratic health care debate: preserving her commitment to the single-payer vision that energizes voters on the left, while offering a less disruptive set of proposals in the short term to those who may be reluctant to give up their existing coverage…

Ms. Warren’s agenda would cost more than $30 trillion. She plans to offset much of that cost through new taxes on the richest Americans and on businesses.

But she would still rely on Democrats winning control of the Senate, where Republicans currently hold a slim majority. And she is laying out ambitious details for getting to a single-payer system even as voter support for the idea is narrowing; polls suggest substantially more Americans prefer the “public option” type of plans that Mr. Biden and Mr. Buttigieg have proposed…”  (H)

“Allowing more time underscores Warren’s — or any candidate’s — difficulty in delivering on government-run universal health coverage. Winning congressional approval would be a heavy lift, no matter which party holds majorities in the House and Senate.

 “Every serious proposal for Medicare for All contemplates a significant transition period,” Warren wrote in an online post. “My plan will be completed in my first term. It includes dramatic actions to lower drug prices, a Medicare for All option available to everyone that is more generous than any plan proposed by any other presidential candidate, critical health system reforms to save money and save lives, and a full transition to Medicare for All.”

Even as she continued to praise Medicare for All, though, Friday’s announcement represented a move toward the political middle on an issue that has been one of the most important to voters in the Democratic primary — which begins Feb. 3 in Iowa…

Taking years to get to Medicare for All would give Warren time to convince people happy with their current, private insurance to accept a fully government-funded system. But Friday’s announcement seems sure to raise more tough questions about health care for a candidate who has been struggling with it lately — following her riding improved polling throughout the summer to become one of the front runners in the crowded Democratic primary field…

She is also recognizing that incremental measures that progressives often dismiss as not going far enough could have a real impact on people’s lives. That view was reinforced by a recent study by the Urban Institute and Commonwealth Fund policy centers, which concluded that Democrats have more than one way to get to coverage for all.

“Warren’s proposals to shore up the Affordable Care Act, lower drug prices, and create a public option would still provide substantial health care cost relief for people,” said the Kaiser Foundation’s Levitt.” (I)

Back in 2010, as Obamacare was about to squeak through Congress, Nancy Pelosi famously declared, “We have to pass the bill so that you can find out what is in it.” This line was willfully misrepresented by Republicans (and some reporters who should have known better) as an admission that there was something underhanded about the way the legislation was enacted. What she meant, however, was that voters wouldn’t fully appreciate the A.C.A. until they experienced its benefits in real life.

It took years to get there, but in the end Pelosi was proved right, as health care became a winning issue for Democrats. In the 2018 midterms and in subsequent state elections, voters punished politicians whom they suspected of wanting to undermine key achievements like protection for pre-existing conditions and, yes, Medicaid expansion…

The lesson I take from the politics of Obamacare, however, is that successful health reform, even if incomplete, creates the preconditions for further reform. What looks impossible now might look very different once tens of millions of additional people have actual experience with expanded Medicare, and can compare it with private insurance.

Although I’ve long argued against making Medicare for All a purity test, there is a good case for eventually going single-payer. But the only way that’s going to happen is via something like Warren’s approach: initial reforms that deliver concrete benefits, and maybe provide a steppingstone to something even bigger.” (J)

“Last week, President Donald Trump signed an executive order titled “Protecting and Improving Medicare for Our Nation’s Seniors.” The order is the latest example of how Trump says one thing while doing another. Rather than strengthening Medicare, Trump envisions turning large swaths of the 54-year-old program for the elderly over to the private sector while directing the federal government to dismantle safeguards on seniors’ health care access, shift costs onto beneficiaries, and limit seniors’ choice of providers.

Among other things, the executive order lays out a path to:

Shift the Medicare program toward private plans

Expand private contracting between beneficiaries and providers, putting seniors at risk for higher costs and surprise medical bills

Further restrict seniors’ choice of providers in Medicare Advantage

Expand Medicare Medical Savings Accounts as a tax shelter for the wealthy.. (K)

  1. A.Why Run For President If You Don’t Want to Fight?, by Sarah Jones, https://www.thecut.com/2019/07/elizabeth-warren-best-question-democratic-debate.html
  2. B.Elizabeth Warren Proposes $20.5 Trillion Health Care Plan, by Thomas Kaplan, Abby Goodnough and Margot Sanger-Katz, https://www.nytimes.com/2019/11/01/us/politics/elizabeth-warren-medicare-for-all.html?smid=nytcore-ios-share
  3. C.Here’s How Warren Finds $20.5 Trillion To Pay For ‘Medicare For All’, by Danielle Kurtzleben, https://www.npr.org/2019/11/01/775339519/heres-how-warren-finds-20-5-trillion-to-pay-for-medicare-for-all
  4. D.Elizabeth Warren’s ‘Medicare for All’ Math, by Margot Sanger-Katz and Sarah Kliff, https://www.nytimes.com/2019/11/01/upshot/elizabeth-warrens-medicare-for-all-math.html?smid=nytcore-ios-share
  5. E.Warren Laces Into Rivals as Iowa Campaign Grows Combative, by Sydney Ember and Reid J. Epstein, https://www.nytimes.com/2019/11/01/us/politics/iowa-democrats.html?smid=nytcore-ios-share
  6. F.Did Warren Pass the Medicare Test? I Think So, by Paul Krugman, https://www.nytimes.com/2019/11/01/opinion/did-warren-pass-the-medicare-test-i-think-so.html?smid=nytcore-ios-share
  7. G.Just Admit There Will Be Premiums in Medicare for All and Get It Over With, by ROBERT VERBRUGGEN, https://www.nationalreview.com/corner/elizabeth-warren-medicare-for-all-plan-there-will-be-premiums/
  8. H.Elizabeth Warren Vows to Expand Health Coverage in First 100 Days, by Abby Goodnough, Thomas Kaplan and Margot Sanger-Katz, https://www.nytimes.com/2019/11/15/us/politics/elizabeth-warren-medicare-for-all-100-days.html?smid=nytcore-ios-share
  9. I.Elizabeth Warren Says ‘Medicare for All’ Rollout Process Will Take 3 Years, by WILL WEISSERT, https://time.com/5730682/elizabeth-warren-medicare-for-all/
  10. J.Doing the Health Care Two-Step, by Paul Krugman, https://www.nytimes.com/2019/11/18/opinion/medicare-for-all.html?smid=nytcore-ios-share
  11. K.Trump’s Plan To Privatize Medicare, by By Emily Gee, Maura Calsyn, and Nicole Rapfogel, https://www.americanprogress.org/issues/healthcare/news/2019/10/11/475646/trumps-plan-privatize-medicare/

SUPPLEMENTARY MATERIAL

S.1129 – Medicare for All Act of 2019

Sponsor: Sen. Sanders, Bernard [I-VT] (Introduced 04/10/2019)

https://www.congress.gov/bill/116th-congress/senate-bill/1129/text

Compare Medicare-for-all and Public Plan Proposals

Where 2020 Democrats stand on Medicare-for-all https://www.washingtonpost.com/graphics/politics/policy-2020/medicare-for-all/

Where the top Democratic U.S. presidential candidates stand on ‘Medicare for All’

https://www.reuters.com/article/us-usa-election-healthcare-factbox/where-the-top-democratic-us-presidential-candidates-stand-on-medicare-for-all-idUSKCN1VV13A

MEDICARE FOR ALL. Use this calculator to find out what Elizabeth’s plan for Medicare for All will mean for you. https://elizabethwarren.com/calculator/medicare-for-all

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