Warren's Medicare for All

I'm reading Elizabeth Warren's proposal for Medicare for All and how to pay for it now. I have not forgotten that she was in the Senate in 2010 and voted to pass the Affordable Care Act health care reform that was supposed to make health care affordable for all.  [Unladylike snort]

Warren believes that removing the risk of bankruptcy from medical bills and the risk of death from unaffordable health care is worth a massive expansion of government bureaucracy, and also an expansion of IRS power to go after "the rich" to get money to pay for Medicare for All, along with an expansion of immigration and a large reduction in combat and counter-terrorism spending.

She claims that she can eliminate health insurance premiums for the middle class while not raising their taxes. Buried in the details, though, she mentions that the income that the middle class would no longer be using to pay health insurance premiums would be subject to the Medicare tax--substantially increasing the amounts that households are paying toward Medicare, even if the tax rate stays the same. This income would also be subject to Social Security and income taxes.

She claims that no one would have to save for medical expenses any more...something that I do not believe will be possible until Revelation 22:2 comes to pass. No earthly plan can cover everything.

She claims that her plan will cover "every single person in the U.S.".  That's one heck of an incentive for the illegal immigration of sick people, some of whom will die painfully on the journey.

She plans to limit growth in health care spending so that it tracks growth in GDP, thus attempting to repeal by fiat the "cost disease" that has caused health care costs to grow far more rapidly than the quantity or quality of health care services. I was at one point working on a post on cost disease, but I got stuck. In some cases, it is clear that the perceived "good" of the service makes people inclined to purchase it even at an unreasonably high or opaque cost, and it seems that sometimes these social perceptions can bubble up to absolutely unsustainable levels. Warren is all the way up at "Health care is a human right!" in social mood, but she plans to sustain it by beating the costs down and the revenue up in any way that she can.

The cornerstone of Warren's Medicare for All plan is to turn employer contributions to health insurance premiums into employer contributions to Medicare. Supposedly she will scale them down a little and save employers a bit of money, but her plan is to make employers pay Medicare contributions based on the average health care costs of their employees. Since Medicare for All will offer more generous coverage than many employers do now, this is likely to increase costs for some employers, and it does nothing to reduce job discrimination against older and sicker people. There is also no guarantee that employers will pass any cost savings on to their employees, except that under collective bargaining agreements, employers can reduce their Medicare contributions by doing so. Which creates an incentive on both sides for increased unionization--and helps the Democrats win back union votes.

An aside:  I believe that unions are only really sustainable when they create enough value for the consumer to justify the costs of the union benefits.  In the old triangle of Better, Faster, Cheaper (where you pick two at most), unions won't be cheaper, and won't really be faster either, so they had better be Better.

Over time, Warren wants to transition the employers' Medicare contributions to a per-employee rate based on a national average cost of health care. This would be quite nasty for employers in lower-income areas, especially when compared against the promises that she is making to adjust some health care providers' pay rates based on regional differences.

Besides workers and employers, her other sources of revenue for Medicare for All are:  tax evaders, the financial sector, big banks, large corporations, multinational corporations, ultra-millionaires and billionaires, legal immigrants, naturalized illegal immigrants, and defense spending. Altogether, her revenue estimates for these only add up to $20.498 trillion, not even half of the nearly $52 trillion that she estimates Medicare for All will cost over ten years. Much of the rest seems to be expected to come from redirected state and federal spending on health care, including the health care benefits paid to government employees, but I can't see how she expects to get to $30 trillion.

Interestingly, she doesn't say anything specific about the money from the premium subsidies currently being given to people buying health insurance on the exchanges. It took some digging to find a national number for this, but from this article it appears that it was $55 billion in 2018, which over ten years would be $0.55 trillion.  Only about 10 million people receive these subsidies, according to this page.

Warren's plan only looks forward ten years, which I believe is too short a time frame, especially when it is based so much on soaking the mega-rich, who tend to not sit still for that kind of treatment. And there are only so many of them.

She has no plan for the thousands and thousands of workers in the health insurance industry who would lose their jobs thanks to Medicare for All.

If you take that number of $52 trillion, and divide by 10 to get the annual number, and then divide again by the approximate population of the United States, 330 million, you get a per capita cost of Medicare for All of $15,757.58.  Unsustainable, in every way.

In the second-to-last paragraph, she says that Obama supports Medicare for All. They'll get it right this time, for sure!