It's real. . . and it's fantastic

Elizabeth Warren introduced her Medicare 4 All plan funding last week and she pulled it off with ZERO new taxes on the middle class.

Funny thing is, detractors immediately countered that taxes will go up on the middle class because the middle class will have higher take home income and that will be taxed. So, yeah, I guess middle class taxes will go up to the extent that middle class take home pay goes up. Take home pay will go up because you will get to keep the health insurance premium you are currently paying out. Health insurance premiums are a tax free deduction while take home pay is not. This increase in take home pay is worth $11 trillion and is bigger than the biggest tax cuts in the history of the country, and will be largely enjoyed by the middle class.

Medicare 4 All will cost the country less than current health care costs the country. Many costs will be shifted from the private sector (which is inefficient at managing health care due to market power imbalances caused by the consumers need to have health care which reduces their negotiating power) to government. In the Warren plan this results in a reduction of premiums and deductibles paid mostly by the middle class and an increase on taxes paid by the wealthy, more efficient health care insurance administration, and other government efficiencies explained below.

This plan is actually better than I expected from a fiscal standpoint. The average American will have more take home pay AND more financially secure health care.

So how is the plan funded?
- A wealth tax. A 2% tax on wealth over $50 million dollars and a 6% wealth tax on wealth over $1 billion dollars. This means if you own $50 million + $1 dollars you will pay a 2 cent wealth tax. If you own $1 billion dollars you will pay a wealth tax of ~$20 million dollars. If you own $2 billion dollars you will pay a wealth tax of ~$80 million, approximately 4% of your wealth. Yes, this has the added benefit of greatly reducing wealth inequality - a feature, not a bug.
- Raise capital gains taxes to equal income taxes for the 1% (I've advocated for this for a long time) and mark--to market for the 1% so they pay the tax every year at its current value. Also, the wealth inequality reduction here is a feature not a bug ($200 billion).
- Current company health care insurance premiums will be converted to a tax ($900 billion)
- Current individual health care insurance premiums will become take home pay and will be taxed at the individuals income tax rate ($1,400 billion)
- Better tax law enforcement (this is a real thing and not a gimmick. Republican Presidents and Legislatures over the years have worked to systematically reduce the ability of the IRS and government in general to enforce tax collection on the wealthy. In fact, today the IRS is more likely to audit the poor than the rich because the IRS can't afford to keep up with the legal fees of the rich. This is by design. It can be stopped and it will result in higher tax revenues) ($230 billion).
- Tax on financial transactions ($80 billion)
- Reduce accelerated depreciation ($125 billion)
- Corporate tax on foreign earnings ($165 billion)
- Immigration reform that will result in higher tax revenues (based on CBO analysis) ($40 billion)
- Reduce defense spending ($80 billion)

Keep in mind that detractors will tell you all this is unrealistic (likely some of the same people who told you the Trump tax cuts would pay for themselves, and that we could implement democracy in the Middle East if we just conquered Iraq, and that the Bill Clinton tax increases would ruin the economy, etc.). The same false criticisms of Obamacare will come out for this plan. The revenue increases won't happen, the government will fail to provide the services, we will all be bankrupted and subject to death panels. Don't believe this garbage. Don't buy into fear - fear that we can't do with health care what every other advanced country in the world does. U.S. healthcare is riddled up and down with inefficiencies. It is very reasonable to expect we can create a more efficient health care insurance system and Elizabeth Warren has the plan.

Every Democrat should support this plan.

What I don't see is any provision to prevent care providers from opting out of Medicare.

I am retired form the Federal government, I kept my Federal health insurance coverage as a supplement to cover expenses not paid by Medicare. Two years I was suffering from a bad infection on my face. I found a local urgent care provider that was part of my Fed health plan. When I had checked in I was informed that this urgent care did not accept Medicare. I had waited at another Urgent care a block away for three hours until my appointment time arrived at the urgent care that did not accept Medicare. I was willing to pay the deductible because the urgent care would not accept Medicare.

My insurance plan would not pay the bill because the urgent care facility had not provided them with Medicare's summary payment. The corporate owner of the urgent care facility told the insurance company that they DO ACCEPT Medicare. The two corporations exchanged messages back and forth for a few months. Meanwhile the Urgent Care Office turned my bill over to a collection agency. All this time my health insurance explanation of benefits showed a zero balance owed to health care provider. My Credit Score dropped over 100 points, if I had still been employed I would have lost my security clearance and have been terminated. Next was conference calls between myself, and claims arbiters at my insurance company and the urgent care provider headquarters.

After the first conference call, nothing changed after promises by the urgent care corporation. A month later the next conference call revealed that was an asterisk in the lower right corner indicating that some Urgent Care offices in Safeway stores did not accept Medicare. That Explained a lot, this urgent care was in a Von's store which several years before had been a Safeway store; the corporate files were out of date...
But it got better, turns out these "Safeway" urgent care facitlities had never asked to be excluded from Medicare; they had to accept Medicare. At this point they promptly billed Medicare who paid in a couple of days and then my insurance settled the complete came the next week.

However my credit scores have never fully recovered. Health care providers have opted out of Medicare, some officially, some just refusing to accept Medicare payments. The Warren plan needs to address the problem, or like the Affordable Care Act some health care providers will leave the public marketplace reducing the pool of providers..

dajo9 said:

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It's real. . . and it's fantastic

Elizabeth Warren introduced her Medicare 4 All plan funding last week and she pulled it off with ZERO new taxes on the middle class.

Funny thing is, detractors immediately countered that taxes will go up on the middle class because the middle class will have higher take home income and that will be taxed. So, yeah, I guess middle class taxes will go up to the extent that middle class take home pay goes up. Take home pay will go up because you will get to keep the health insurance premium you are currently paying out. Health insurance premiums are a tax free deduction while take home pay is not. This increase in take home pay is worth $11 trillion and is bigger than the biggest tax cuts in the history of the country, and will be largely enjoyed by the middle class.

Medicare 4 All will cost the country less than current health care costs the country. Many costs will be shifted from the private sector (which is inefficient at managing health care due to market power imbalances caused by the consumers need to have health care which reduces their negotiating power) to government. In the Warren plan this results in a reduction of premiums and deductibles paid mostly by the middle class and an increase on taxes paid by the wealthy, more efficient health care insurance administration, and other government efficiencies explained below.

This plan is actually better than I expected from a fiscal standpoint. The average American will have more take home pay AND more financially secure health care.

So how is the plan funded?
- A wealth tax. A 2% tax on wealth over $50 million dollars and a 6% wealth tax on wealth over $1 billion dollars. This means if you own $50 million + $1 dollars you will pay a 2 cent wealth tax. If you own $1 billion dollars you will pay a wealth tax of ~$20 million dollars. If you own $2 billion dollars you will pay a wealth tax of ~$80 million, approximately 4% of your wealth. Yes, this has the added benefit of greatly reducing wealth inequality - a feature, not a bug.
- Raise capital gains taxes to equal income taxes for the 1% (I've advocated for this for a long time) and mark--to market for the 1% so they pay the tax every year at its current value. Also, the wealth inequality reduction here is a feature not a bug.
- Current company health care insurance premiums will be converted to a tax
- Current individual health care insurance premiums will become take home pay and will be taxed at the individuals income tax rate
- Better tax law enforcement (this is a real thing and not a gimmick. Republican Presidents and Legislatures over the years have worked to systematically reduce the ability of the IRS and government in general to enforce tax collection on the wealthy. In fact, today the IRS is more likely to audit the poor than the rich because the IRS can't afford to keep up with the legal fees of the rich. This is by design. It can be stopped and it will result in higher tax revenues).
- Tax on financial transactions
- Reduce accelerated depreciation
- Corporate tax on foreign earnings
- Immigration reform that will result in higher tax revenues (based on CBO analysis)
- Reduce defense spending

Keep in mind that detractors will tell you all this is unrealistic (likely some of the same people who told you the Trump tax cuts would pay for themselves, and that we could implement democracy in the Middle East if we just conquered Iraq, and that the Bill Clinton tax increases would ruin the economy, etc.). The same false criticisms of Obamacare will come out for this plan. The revenue increases won't happen, the government will fail to provide the services, we will all be bankrupted and subject to death panels. Don't believe this garbage. Don't buy into fear - fear that we can't do with health care what every other advanced country in the world does. U.S. healthcare is riddled up and down with inefficiencies. It is very reasonable to expect we can create a more efficient health care insurance system and Elizabeth Warren has the plan.

Every Democrat should support this plan.

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Every Democrat should support BERNIE'S PLAN. It's real and it is not fantastic and I mean the literal definition of fantastic. I encourage every liberal to actually compare the plans. Bernie's coverage is every bit as good if not better and he has a realistic plan to pay for it (though he doesn't have every cent accounted for, his system could actually work)

The major difference is Bernie refuses to lie to you. In broad strokes Bernie takes the insurance premiums your employer pays and the insurance premiums you pay, and diverts them into a tax to fund Medicare. If you are poor, you pay a little less. If you are wealthy or upper middle class, you pay a little more. If you are in the middle you pay about the same. That won't fund the whole plan, but it gets us most of the way there in a fair and reasonable way that does not add ADDITIONAL cost for most Americans. That is why Bernie keeps saying it won't COST the middle class anymore.

Watch Warren leading up to and in the last debate. She keeps using Bernie's language that it wont cost more, but she refuses to say there will be any additional taxes. She stammers around not wanting to give the soundbite. Frankly, I was ready to scream at my television "Why can't you just say instead of paying private insurers, you will pay the Medicare plan and premiums won't go up?" That is fair and reasonable and simple to understand. The CURRENT Medicare system is funded through payroll tax. How is this hard? The other Democrats were trying to pin her down (and not Bernie who had already said this) because she was implying it would all be free.

So now she has doubled down on free. So let's summarize. Everyone who has no insurance will now get health care. In most cases the health care will be better than people got before. We will wipe out the average $10,000 each American pays for health care every year. And we will pay for it by taxing the rich, corporations, and cutting some spending and administrative costs. Oh, and just so you know, I really can't get this passed (yes, she said that). What she didn't say is "and of course since I can't get this passed, I can promise whatever I want. Free ice cream for all!" Simply stated, there are not enough rich people and corporations to pay for this.

Let's talk about some broad numbers. And I'm going to use her numbers, rosy as they are. Her plan says that American workers will spend $11 trillion in insurance premiums in the next 10 years and she will eliminate that (and, by the way, assumes that there will be no impact on wages and salaries in the market, but let's not complicate things). The government will take on $11 trillion and burden over the next 10 years. Her very optimistic projections for the wealth tax is $2.75 trillion over 10 years. Not going to pay for it.
So she is taking on $1.1 trillion annually of health care burden AND that is just to cover the people who are already insured, not to add any uninsured or under insured. The entire revenues projected to be collected by the US government for 2020 is $3.6 trillion. The budget is $4.7 trillion. So somehow she is going to increase revenues by 30% without you paying anything, and she hasn't even started to pay to cover the currently uninsured yet. And we still have a huge deficit. THIS IS BY HER NUMBERS. It is a ridiculous claim which tells me she has no intent to follow through. Bernie intends to follow through, so he is telling you that what you pay for healthcare now, you will have to pay into the system. That is realistic. That is fair.

I have gone through many of the plans on Warren's website. You know the song 12 Days of Christmas? Where it always ends with "and a partridge in a pair tree!" Every Warren plan ends with "and I'll pay for it with wealth tax!" And if you read one plan, that is great. She can pay for it with a wealth tax. (at least by her numbers). But her plans overall are like the movie The Producers where they sell a 10% stake in the show to like a 100 people never planning on making any money. She can pay for 1 or 2 plans USING HER NUMBERS, but she can't come close to paying for all of them. But still she claims the wealth tax for each individual plan. As a for instance, she says she will pay for her plan to upgrade public schools and give a free college education (which depends, by the way, on states agreeing to pay half the tuition) with a wealth tax. And by her very dubious numbers, the wealth tax will pay for those two plans and at that point be entirely used up. But then she has like a million other plans like universal childcare that she says she can pay for with the wealth tax (by her figuring that plan would eat up 25% of the wealth tax) AGAIN, THESE ARE BY HER NUMBERS.

The reason why she stammered so much on paying for Medicare for all is that it was one plan that could not be paid for by the wealth tax. So having to do something, she went on to Bernie's website took a bunch of his taxation plans and heaped them on. Only that still didn't get her remotely close, so she called on Ronald Reagan and voodoo economics to fill the gap. There will be more taxes because people will earn more money bullshyte. Here's an example. Private health insurers spend a lot of administrative costs reviewing claims to deny people coverage. We won't be denying people coverage so won't have to pay those costs that just go to take your health coverage away. So here is the thing with that. Private insurers are not denying claims for the hell of it. They are denying claims to increase their profits. They are paying less to administer a system of denying claims then the cost of the health care they would have to provide if they didn't deny claims. RIGHT? They are not reducing profits in order to deny claims. So we may reduce the administrative cost of reviewing claims, but we will logically pay more IN PROVIDING THE HEALTHCARE THAT WAS PREVIOUSLY DENIED. That is a great thing. IT ISN'T A COST SAVINGS.

Let me explain that I do not love any of the candidates running. Leading up to the last debate, I was resolved that out of the candidates that seemed to have a realistic shot, Warren was probably my candidate. I had bought that she was a "more realistic Bernie". I was 95% there and I watched the debate to seal the deal. She had me in the office ready to close. I listened to that debate and had many W T F moments. So I did a lot of research mostly on her own site. And now I'm ticked off. She is selling snake oil. And I believe like in The Producers since she has made 20 promises she can't keep, she intends to keep none of them.

I am not the "same people that told you the Trump tax cuts would pay for themselves" If you want to look for people using the same arguments, look to Elizabeth Warren. No, she is not a racist, divisive, loud mouthed, lout, poor excuse for a human being, but on the policy front she is selling snake oil just as much he is. Further, she and her people are doing an absolutely fabulous job of painting everyone that challenges anything she says as not only not a liberal but as Trumpian corporate conservatives. It's despicable.

If liberals fail to challenge her on these issues now, you can bet the conservatives will easily uncover all of this in the general election. We better hope that people are stupid enough to buy it. I think that is a bad strategy for Democrats. We've seen educated voters who saw right through Trump coming to us in droves. This is not the time to challenge with stupidity on the other side.

I'm ticked off about this because I really care about these policies and have all my life. I would support virtually every policy she is proposing. To be clear, though, she isn't remotely the only one proposing them. She is the only one proposing them for free. I want Medicare for All. I want affordable childcare. I want public universities to go back to the promise of providing a free education. I realize there is a cost to doing those things. I'm willing to pay that cost. To effectuate those policies, we need to have a real conversation. Anyone promising these things for free has no intention of passing them.

If you like what Warren is selling, vote for Bernie. He has a lot of problems with reality too, but he is serious and he is trying. Warren has just released a bunch of complicated plan documents that are a big shell game. She is promising liberals everything they ever wanted with no means to get there and attacking every Democrat that challenges her. As several said at the debate, they want the same things they just don't by into her methods of getting them.

I have no idea who I'm voting for. I don't like being lied to. Warren will get my vote against one man in the crappy event that is the option given to me. (okay, not true. I'll also vote for her in the unlikely event I have to stop Tulsi Gabbard).

Professor there are many things I don't like about you, but I owe you an apology on this one, Warren is no liberal. She is using liberals. (I think you owe me an apology for painting me as a corporate conservative, but that is up to you.)

Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

Sp4149, it's going to be hard for providers to turn down Medicare when it's the only game in town. What you describe is a common problem of the current system and why we need to find a new way.

dajo9 said:

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Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

---

First of all, no I didn't. Second of all the other "funding mechanisms" are minor. The strategy of her plans is to throw out meaningless details all of which are ridiculous and get you arguing over each one and no one can tell who is right and who is wrong with all that complication. I'm not going to get drawn into it when the overall numbers are ridiculous on their face. I am perfectly happy making this simple argument.

The total US revenues for 2020 is projected at $3.6 trillion dollars.

One part of her plan is to remove $1.1 trillion dollars in private funding out of the health care system (what you and I as private citizens pay for health care). This would be paid for by the government. That is a nearly 25% increase in total federal government spending just to eliminate what individuals currently pay on their own. Her numbers.


Does anyone believe that there is ANY set of funding mechanisms that can add 30% to the total US revenues without a general tax on the population?

Further, the money from the wealth tax that she has earmarked for this, she has earmarked more than 10 times over for all of her other plans.


This is only part of the plan that needs to be funded. Doing this just gets us exactly what we have today, but you and I are no longer paying for health insurance. It does not cover people who are not insured today or who are under insured. It does not pay for new administrative costs that Medicare does not currently have. All it does is absolve you of your health insurance premium.

I'm 100% for Medicare for all. Paid for through a payroll tax that is roughly equivalent to the premiums I pay today. Just like existing Medicare. Just like social security. Just like that corporate conservative wretch Bernie Sanders is proposing. Medicare for all is a plan that can absolutely be funded in a reasonable way without causing any more pain to the American taxpayer than they already have. It cannot be funded by making it Medicare for all for free.

Democrats have always fudged slightly on implying they can fund things by taxing the wealthy. It is very attractive because the tax system is massively and unfairly skewed to benefit the uber wealthy and that needs to be fixed in a big way. But there aren't enough rich people to tax to pay for everything. Warren has gone build the wall on this. There's no fudging. It's just full on "I'm going to give you everything you have ever wanted in life and make Mark Zuckerberg pay for it. Hooray!" I'm happy to screw over Mark Zuckerberg. But it won't pay for everything.

You likely can't even balance the current budget taxing the rich more. It's her easy answer for everything.

What Warren needs is an infographic explaining clearly and concisely how MCFA works, and how you save money and what you can expect. You know, make it simple and clear. I understand this is early but you have to communicate this stuff.

Otherwise, bring it...American healthcare is basically a penalty on companies (compared to other industrialized nations) and individuals. I'll just say it - kill of the U.S. healthcare "insurance" industry. It's an useless middleman that sucks of resources without any kind of return and serves no other function.

dajo9 said:

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Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

---

I'm going to point out one of the mechanisms you listed. Immigration reform. Yeah. Okay. That's a serious funding mechanism.

It reminds me of a University of Chicago study that came out in the lead up to the Iraq war (second version). The Iraq war was going to save us money. The theory. We were currently paying $X to patrol Iraq. The Iraq war would cost $10X dollars over the next year to achieve all of our aims. After that there would be no patrolling. We would be paying $0 in Iraq. In 10 years we'd break even and it would all be gravy. I laughed as anyone should have.

The funding mechanisms listed are of similar quality.

Healthcare paid for by Immigration reform. A liberal two fer. I can't believe this yogurt is nonfat!

Another Bear said:

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What Warren needs is an infographic explaining clearly and concisely how MCFA works, and how you save money and what you can expect. You know, make it simple and clear. I understand this is early but you have to communicate this stuff.

Otherwise, bring it...American healthcare is basically a penalty on companies (compared to other industrialized nations) and individuals. I'll just say it - kill of the U.S. healthcare "insurance" industry. It's an useless middleman that sucks of resources without any kind of return and serves no other function.

---

The thing is, there is a great case for this and Bernie is making it. I firmly believe it will ultimately cost all of us less. If that is what she were promising, I'd cheer her on. She isn't promising it costing less. She is promising it for free. That is not possible. The ridiculous claim makes those that support Bernie's plan have to work 1000 times harder. Proposing and selling this plan will set the cause of universal healthcare back to 1992. She doesn't care as long as she gets some votes.

OaktownBear said:

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Another Bear said:

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What Warren needs is an infographic explaining clearly and concisely how MCFA works, and how you save money and what you can expect. You know, make it simple and clear. I understand this is early but you have to communicate this stuff.

Otherwise, bring it...American healthcare is basically a penalty on companies (compared to other industrialized nations) and individuals. I'll just say it - kill of the U.S. healthcare "insurance" industry. It's an useless middleman that sucks of resources without any kind of return and serves no other function.

---

The thing is, there is a great case for this and Bernie is making it. I firmly believe it will ultimately cost all of us less. If that is what she were promising, I'd cheer her on. She isn't promising it costing less. She is promising it for free. That is not possible. The ridiculous claim makes those that support Bernie's plan have to work 1000 times harder. Proposing and selling this plan will set the cause of universal healthcare back to 1992. She doesn't care as long as she gets some votes.

---

Policy wise I like Bernie. I don't like him as POTUS however. Too rough around the edges. He's a cranky old mother. I respect that but I don't want that as POTUS. I'm backing Warren because of pragmatism. I think she can win and then govern. She will get GOP pushback but it will be nothing like Bernie. Also the Democrat establishment LOVE Warren, even if the party line is they want a moderate Dem.

The big pluses for Warren is that she doesn't have any major haters like HRC, Bernie, Obama. She seems very inoffensive and wanting to do what's good for the country.

In any case, once Bernie and Warren made an agreement of sorts that they both back the same plan, but Bernie created it, I'm good.

OaktownBear said:

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dajo9 said:

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Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

---

I'm going to point out one of the mechanisms you listed. Immigration reform. Yeah. Okay. That's a serious funding mechanism.

It reminds me of a University of Chicago study that came out in the lead up to the Iraq war (second version). The Iraq war was going to save us money. The theory. We were currently paying $X to patrol Iraq. The Iraq war would cost $10X dollars over the next year to achieve all of our aims. After that there would be no patrolling. We would be paying $0 in Iraq. In 10 years we'd break even and it would all be gravy. I laughed as anyone should have.

The funding mechanisms listed are of similar quality.

Healthcare paid for by Immigration reform. A liberal two fer. I can't believe this yogurt is nonfat!

---

The University of Chicago is notorious for pie-in-the-sky conservative prognosticating foolishness. Warren's immigration reform tax revenue comes from the CBO. Your false equivalencies are sad and based from fear.

Furthermore, some of Sanders funding mechanisms are downright foolish in the 21st century. A 70% tax on incomes above $10 million (as Sanders has proposed)? That may have worked in the 1950's when only industry giants who were tied down to local capital might earn that income, but that kind of marginal tax rate wouldn't work in today's society. There is a reason why the liberal, hippy Beatles wrote a song called Tax Man complaining about onerous taxes on the wealthy "19 for you and 1 for me". The Rolling Stones moved to France to get away from these kinds of taxes. What do you think would happen to Hollywood with an 80% tax rate on income above $10 million? It would cease to exist. Capital may try to flee but that can be regulated better than an entertainer's residence - there aren't very many U.S. capital markets.

It's too bad you have "decided" not to take Warren's proposals seriously. But that's on you, not on her plan.

dajo9 said:

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OaktownBear said:

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dajo9 said:

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Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

---

I'm going to point out one of the mechanisms you listed. Immigration reform. Yeah. Okay. That's a serious funding mechanism.

It reminds me of a University of Chicago study that came out in the lead up to the Iraq war (second version). The Iraq war was going to save us money. The theory. We were currently paying $X to patrol Iraq. The Iraq war would cost $10X dollars over the next year to achieve all of our aims. After that there would be no patrolling. We would be paying $0 in Iraq. In 10 years we'd break even and it would all be gravy. I laughed as anyone should have.

The funding mechanisms listed are of similar quality.

Healthcare paid for by Immigration reform. A liberal two fer. I can't believe this yogurt is nonfat!

---

The University of Chicago is notorious for pie-in-the-sky conservative prognosticating foolishness. Warren's immigration reform tax revenue comes from the CBO. Your false equivalencies are sad and based from fear.

Furthermore, some of Sanders funding mechanisms are downright foolish in the 21st century. A 70% tax on incomes above $10 million (as Sanders has proposed)? That may have worked in the 1950's when only industry giants who were tied down to local capital might earn that income, but that kind of marginal tax rate wouldn't work in today's society. There is a reason why the liberal, hippy Beatles wrote a song called Tax Man complaining about onerous taxes on the wealthy "19 for you and 1 for me". The Rolling Stones moved to France to get away from these kinds of taxes. What do you think would happen to Hollywood with an 80% tax rate on income above $10 million? It would cease to exist. Capital may try to flee but that can be regulated better than an entertainer's residence - there aren't very many U.S. capital markets.

It's too bad you have "decided" not to take Warren's proposals seriously. But that's on you, not on her plan.

---

Fear would be I didn't read her plan. I read her plan. Have you?

25% increase in new government spending. No payroll tax. No general tax. By her numbers she is adding a government benefit that costs more than social security and doing it free of charge to 99.9% of Americans. It is not fear to say that isn't possible

The fear crack is bull. That is what you say to people who don't support a health care program. Again another Warren supporter who name calls anyone who challenges her.

I support Bernie's program. That puts me left of a large majority of the country on the issue. He is not proposing paying for it with a 70% tax. (He May be proposing the tax but not to pay for healthcare.). Once she promised healthcare without premiums or taxes you know what kind of candidate she is.

As for uchicago, yeah, I agree. What do you think of calculating proceeds of a wealth tax based on current assets and not factoring in wealthy taking tax avoidance measures. (Which is why wealth tax has been tried and repealed in several countries)

Let's be clear here. Her plan is a dream. As is, it will never be implemented.

OaktownBear said:

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dajo9 said:

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OaktownBear said:

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dajo9 said:

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Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

---

I'm going to point out one of the mechanisms you listed. Immigration reform. Yeah. Okay. That's a serious funding mechanism.

It reminds me of a University of Chicago study that came out in the lead up to the Iraq war (second version). The Iraq war was going to save us money. The theory. We were currently paying $X to patrol Iraq. The Iraq war would cost $10X dollars over the next year to achieve all of our aims. After that there would be no patrolling. We would be paying $0 in Iraq. In 10 years we'd break even and it would all be gravy. I laughed as anyone should have.

The funding mechanisms listed are of similar quality.

Healthcare paid for by Immigration reform. A liberal two fer. I can't believe this yogurt is nonfat!

---

The University of Chicago is notorious for pie-in-the-sky conservative prognosticating foolishness. Warren's immigration reform tax revenue comes from the CBO. Your false equivalencies are sad and based from fear.

Furthermore, some of Sanders funding mechanisms are downright foolish in the 21st century. A 70% tax on incomes above $10 million (as Sanders has proposed)? That may have worked in the 1950's when only industry giants who were tied down to local capital might earn that income, but that kind of marginal tax rate wouldn't work in today's society. There is a reason why the liberal, hippy Beatles wrote a song called Tax Man complaining about onerous taxes on the wealthy "19 for you and 1 for me". The Rolling Stones moved to France to get away from these kinds of taxes. What do you think would happen to Hollywood with an 80% tax rate on income above $10 million? It would cease to exist. Capital may try to flee but that can be regulated better than an entertainer's residence - there aren't very many U.S. capital markets.

It's too bad you have "decided" not to take Warren's proposals seriously. But that's on you, not on her plan.

---

Fear would be I didn't read her plan. I read her plan. Have you?

25% increase in new government spending. No payroll tax. No general tax. By her numbers she is adding a government benefit that costs more than social security and doing it free of charge to 99.9% of Americans. It is not fear to say that isn't possible

The fear crack is bull. That is what you say to people who don't support a health care program. Again another Warren supporter who name calls anyone who challenges her.

I support Bernie's program. That puts me left of a large majority of the country on the issue. He is not proposing paying for it with a 70% tax. (He May be proposing the tax but not to pay for healthcare.). Once she promised healthcare without premiums or taxes you know what kind of candidate she is.

As for uchicago, yeah, I agree. What do you think of calculating proceeds of a wealth tax based on current assets and not factoring in wealthy taking tax avoidance measures. (Which is why wealth tax has been tried and repealed in several countries)

---

I listed 7 different taxes that will fund the Warren plan.

Effing liberals. Dont like a plan because it doesn't tax enough.

dajo9 said:

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OaktownBear said:

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dajo9 said:

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OaktownBear said:

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dajo9 said:

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Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

---

I'm going to point out one of the mechanisms you listed. Immigration reform. Yeah. Okay. That's a serious funding mechanism.

It reminds me of a University of Chicago study that came out in the lead up to the Iraq war (second version). The Iraq war was going to save us money. The theory. We were currently paying $X to patrol Iraq. The Iraq war would cost $10X dollars over the next year to achieve all of our aims. After that there would be no patrolling. We would be paying $0 in Iraq. In 10 years we'd break even and it would all be gravy. I laughed as anyone should have.

The funding mechanisms listed are of similar quality.

Healthcare paid for by Immigration reform. A liberal two fer. I can't believe this yogurt is nonfat!

---

The University of Chicago is notorious for pie-in-the-sky conservative prognosticating foolishness. Warren's immigration reform tax revenue comes from the CBO. Your false equivalencies are sad and based from fear.

Furthermore, some of Sanders funding mechanisms are downright foolish in the 21st century. A 70% tax on incomes above $10 million (as Sanders has proposed)? That may have worked in the 1950's when only industry giants who were tied down to local capital might earn that income, but that kind of marginal tax rate wouldn't work in today's society. There is a reason why the liberal, hippy Beatles wrote a song called Tax Man complaining about onerous taxes on the wealthy "19 for you and 1 for me". The Rolling Stones moved to France to get away from these kinds of taxes. What do you think would happen to Hollywood with an 80% tax rate on income above $10 million? It would cease to exist. Capital may try to flee but that can be regulated better than an entertainer's residence - there aren't very many U.S. capital markets.

It's too bad you have "decided" not to take Warren's proposals seriously. But that's on you, not on her plan.

---

Fear would be I didn't read her plan. I read her plan. Have you?

25% increase in new government spending. No payroll tax. No general tax. By her numbers she is adding a government benefit that costs more than social security and doing it free of charge to 99.9% of Americans. It is not fear to say that isn't possible

The fear crack is bull. That is what you say to people who don't support a health care program. Again another Warren supporter who name calls anyone who challenges her.

I support Bernie's program. That puts me left of a large majority of the country on the issue. He is not proposing paying for it with a 70% tax. (He May be proposing the tax but not to pay for healthcare.). Once she promised healthcare without premiums or taxes you know what kind of candidate she is.

As for uchicago, yeah, I agree. What do you think of calculating proceeds of a wealth tax based on current assets and not factoring in wealthy taking tax avoidance measures. (Which is why wealth tax has been tried and repealed in several countries)

---

I listed 7 different taxes that will fund the Warren plan.

Effing liberals. Dont like a plan because it doesn't tax enough.

---

Please explain how those 7 taxes raise $1.1 trillion a year, equal to over 30% of the current total tax revenue. Do the math. Listing things without analyzing the numbers beyond "Warren said so" doesn't cut it

Anybody who believes that you can add a government expense larger than social security and not tax the bottom 99.9 percent wants to believe in Santa Claus.

Again, Bernie's plan actually works. He's honest. She's a big phony. You will get no healthcare plan from her.

Hopefully she has jumped the shark on this - made a promise so ludicrous that anyone with any sense can see it and start questioning every other claim she has made.

OaktownBear said:

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dajo9 said:

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OaktownBear said:

---

dajo9 said:

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OaktownBear said:

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dajo9 said:

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Oaktownbear, I listed 10 funding mechanisms and you singled out 1 of them and said it's not enough. You also complain about her not saying more about her plan before it was fully formulated, like it is now.

Try again.

---

I'm going to point out one of the mechanisms you listed. Immigration reform. Yeah. Okay. That's a serious funding mechanism.

It reminds me of a University of Chicago study that came out in the lead up to the Iraq war (second version). The Iraq war was going to save us money. The theory. We were currently paying $X to patrol Iraq. The Iraq war would cost $10X dollars over the next year to achieve all of our aims. After that there would be no patrolling. We would be paying $0 in Iraq. In 10 years we'd break even and it would all be gravy. I laughed as anyone should have.

The funding mechanisms listed are of similar quality.

Healthcare paid for by Immigration reform. A liberal two fer. I can't believe this yogurt is nonfat!

---

The University of Chicago is notorious for pie-in-the-sky conservative prognosticating foolishness. Warren's immigration reform tax revenue comes from the CBO. Your false equivalencies are sad and based from fear.

Furthermore, some of Sanders funding mechanisms are downright foolish in the 21st century. A 70% tax on incomes above $10 million (as Sanders has proposed)? That may have worked in the 1950's when only industry giants who were tied down to local capital might earn that income, but that kind of marginal tax rate wouldn't work in today's society. There is a reason why the liberal, hippy Beatles wrote a song called Tax Man complaining about onerous taxes on the wealthy "19 for you and 1 for me". The Rolling Stones moved to France to get away from these kinds of taxes. What do you think would happen to Hollywood with an 80% tax rate on income above $10 million? It would cease to exist. Capital may try to flee but that can be regulated better than an entertainer's residence - there aren't very many U.S. capital markets.

It's too bad you have "decided" not to take Warren's proposals seriously. But that's on you, not on her plan.

---

Fear would be I didn't read her plan. I read her plan. Have you?

25% increase in new government spending. No payroll tax. No general tax. By her numbers she is adding a government benefit that costs more than social security and doing it free of charge to 99.9% of Americans. It is not fear to say that isn't possible

The fear crack is bull. That is what you say to people who don't support a health care program. Again another Warren supporter who name calls anyone who challenges her.

I support Bernie's program. That puts me left of a large majority of the country on the issue. He is not proposing paying for it with a 70% tax. (He May be proposing the tax but not to pay for healthcare.). Once she promised healthcare without premiums or taxes you know what kind of candidate she is.

As for uchicago, yeah, I agree. What do you think of calculating proceeds of a wealth tax based on current assets and not factoring in wealthy taking tax avoidance measures. (Which is why wealth tax has been tried and repealed in several countries)

---

I listed 7 different taxes that will fund the Warren plan.

Effing liberals. Dont like a plan because it doesn't tax enough.

---

Please explain how those 7 taxes raise $1.1 trillion a year, equal to over 30% of the current total tax revenue. Do the math. Listing things without analyzing the numbers beyond "Warren said so" doesn't cut it

Anybody who believes that you can add a government expense larger than social security and not tax the bottom 99.9 percent wants to believe in Santa Claus.

Again, Bernie's plan actually works. He's honest. She's a big phony. You will get no healthcare plan from her.

Hopefully she has jumped the shark on this - made a promise so ludicrous that anyone with any sense can see it and start questioning every other claim she has made.

---

I thought you said you read the plan -

I edited my original post adding the dollars for each item in parenthesis. It sums to $2 trillion / year. To better understand, about half the funding will basically come from converting employee health care premiums to a tax ($880 billion) and higher income tax receipts from individual health care premiums being converted into take home pay ($140 billion). The rest is just a slew of reasonable ideas that can bridge the gap.

How do you know this policy is so reasonably grounded? By the deafening silence of the corporate punditry class. If there were legitimate holes in the proposal the corporate media would be offering blanket coverage.

Edited to fix inaccuracies

wifeisafurd said:

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Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. Medicare for all is less expensive than the current system, benefits held equal. This is a definite gain for the American people.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. There are huge gains to be made from our current inefficient system and Elizabeth Warren has the balls to go after them. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

Edited to fix inaccuracies

NYCGOBEARS said:

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Let's be clear here. Her plan is a dream. As is, it will never be implemented.

---

All you have to do is make the conscious decision to be an advocate for something good instead of fearful of hurdles.

I spent my entire career in health care finance and I'll stipulate that there's plenty wrong with the current system, but I'm terrified of Medicare for all primarily for a single reason -- fee-for-service Medicare does not have an effective utilization review system.

For about five years I was in charge of hospital-physician joint venture that provided service to roughly 12,000 Medicare beneficiaries. They were split almost evenly between traditional government fee-for-service Medicare and a private insurance plan that paid us a fixed amount per month. The two populations were essentially demographically identical. The physicians were skeptical of the private plan, so to get them on board, the hospital agreed that their portion of the fixed payment would leave them no worse off than if they had received Medicare payments for their treatment of the plan's patients. What we found was that the fee-for-service population's cost ran about 20% more than the fixed payment group, with no discernible difference in outcomes. And this was with no fraud involved, which is a big issue with Medicare. This reinforced all my other (admittedly anecdotal) experience with Medicare.

In other words, I think Medicare is actually far less efficient than private insurance and as a result Medicare for all will prove far more costly than any of the plans put forward predict

LudwigsFountain said:

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I spent my entire career in health care finance and I'll stipulate that there's plenty wrong with the current system, but I'm terrified of Medicare for all primarily for a single reason -- fee-for-service Medicare does not have an effective utilization review system.

For about five years I was in charge of hospital-physician joint venture that provided service to roughly 12,000 Medicare beneficiaries. They were split almost evenly between traditional government fee-for-service Medicare and a private insurance plan that paid us a fixed amount per month. The two populations were essentially demographically identical. The physicians were skeptical of the private plan, so to get them on board, the hospital agreed that their portion of the fixed payment would leave them no worse off than if they had received Medicare payments for their treatment of the plan's patients. What we found was that the fee-for-service population's cost ran about 20% more than the fixed payment group, with no discernible difference in outcomes. And this was with no fraud involved, which is a big issue with Medicare. This reinforced all my other (admittedly anecdotal) experience with Medicare.

In other words, I think Medicare is actually far less efficient than private insurance and as a result Medicare for all will prove far more costly than any of the plans put forward predict

---

Fee for service is an inefficiency of the current system both in Medicare and private insurance. Legislation has been passed to address this challenging issue going back to the GWB administration, Obamacare, and it is addressed in every plan out forward (Warren, Sanders, etc.).

It's a challenge, no doubt but not a challenge solely of Medicare. The vast majority of private insurance pays fee for service.

NYCGOBEARS said:

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Let's be clear here. Her plan is a dream. As is, it will never be implemented.

---

This is pretty much reality. Warren's healthcare proposal is a blue sky or pie in the sky, get everything platform plank. Some would call it aspirational but everyone benefits if everyone is covered in a reasonable system. 10% annual insurance premium increase is NOT reasonable, or sustainable.

On that note...start the negotiations. This is how sausage and democracy is made...often ugly but it's what we have. And if that's the case, I want Warren doing this. She's a senator so she understands legislation and I believe she has the intellectual ability to craft something and see the options, instead of Trump saying "No body knew healthcare could be so complicated".

The other thing, Warren doesn't have any major haters like HRC or Obama. She's likable and I believe that will help but she's also smart and she'll at least try go arounds if the GOP obstruct.

LudwigsFountain said:

---

I spent my entire career in health care finance and I'll stipulate that there's plenty wrong with the current system, but I'm terrified of Medicare for all primarily for a single reason -- fee-for-service Medicare does not have an effective utilization review system.

For about five years I was in charge of hospital-physician joint venture that provided service to roughly 12,000 Medicare beneficiaries. They were split almost evenly between traditional government fee-for-service Medicare and a private insurance plan that paid us a fixed amount per month. The two populations were essentially demographically identical. The physicians were skeptical of the private plan, so to get them on board, the hospital agreed that their portion of the fixed payment would leave them no worse off than if they had received Medicare payments for their treatment of the plan's patients. What we found was that the fee-for-service population's cost ran about 20% more than the fixed payment group, with no discernible difference in outcomes. And this was with no fraud involved, which is a big issue with Medicare. This reinforced all my other (admittedly anecdotal) experience with Medicare.

In other words, I think Medicare is actually far less efficient than private insurance and as a result Medicare for all will prove far more costly than any of the plans put forward predict

---

My experience is that Medicare pays health providers or others far less than private insurance, except for prescriptions, and that some doctors or hospitals thatt serve the wealthy just don't take Medicare, but everyone else dose, because otherwise you are missing to much of the patient market. Admittedly Medicare does audit, just ask UCLA. Doctors live in fear of Medicare audits. I understand than in specific situations Medicare may be less efficient, but on the whole the numbers don't lie when I get my cost statements. It is not even close to what my propitiate insurer paid.

dajo9 said:

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wifeisafurd said:

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Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. The $20 trillion of funding over 10 years is potential sources of revenue. The actual price tag is about half that at $11 trillion over 10 years (Oaktownbear prefers $1.1 trillion annually). Immigration reform and many of the other funding mechanisms Warren lists are immaterial to the actual price tag, as I realized while answering Oaktownbear's post above. Warren should have probably kept it simple, showed fewer funding mechanisms and still easily covered the $11 trillion / 10 year price tag.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. We can pay for a new system with our current spending and lower costs and have more money at the end of the day. That is what inefficiency means. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

---

First, appreciate that in some ways you are preaching to the choir, we need universal care for a lot of reasons. My concern still is that the way Warren has chosen to do everything at once, and to fund the health program requires a constitutional amendment, a complete overall of the tax code, some way to cut military that is acceptable, change the way tax treaties are structured (which won't happen), forge an immigration agreement that on has been able to do, make banks unprofitable or at least less stable, tax transaction (which has evasion written all over it), and one thing after another that pisses off some group of voters. Why not just simply tax everyone/? I get politicians want to pander to the middle class, whatever that is, but maybe everyone should pay for health care in a simple tax, since they all benefit from health care, and for most people it will be cheaper that the tax?

Separate from that, I know Sanders and his people have spent years dealing with single payor to derive their numbers. Is there some analysis out there why Sanders is so wrong on the numbers and Warren right/? it is easy to just say efficiencies, but anything we can read that says why Sanders is so wrong?

The problem politically is Warren has chosen a route to change all these different sectors of the economy or government without really addressing the reality of doing so, or the consequences of doing so, and wanting to do it all right now. Most countries have universal health care by charging a universal tax or fee to users. There are reasons for their simplicity. Maybe Warren is posturing and will be more pragmatic as a leader, assuming she can get elected. But the current leader promised a lot that people said can't structurally or practically happen, and he has not pivoted to reality.

wifeisafurd said:

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dajo9 said:

---

wifeisafurd said:

---

Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. The $20 trillion of funding over 10 years is potential sources of revenue. The actual price tag is about half that at $11 trillion over 10 years (Oaktownbear prefers $1.1 trillion annually). Immigration reform and many of the other funding mechanisms Warren lists are immaterial to the actual price tag, as I realized while answering Oaktownbear's post above. Warren should have probably kept it simple, showed fewer funding mechanisms and still easily covered the $11 trillion / 10 year price tag.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. We can pay for a new system with our current spending and lower costs and have more money at the end of the day. That is what inefficiency means. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

---

First, appreciate that in some ways you are preaching to the choir, we need universal care for a lot of reasons. My concern still is that the way Warren has chosen to do everything at once, and to fund the health program requires a constitutional amendment, a complete overall of the tax code, some way to cut military that is acceptable, change the way tax treaties are structured (which won't happen), forge an immigration agreement that on has been able to do, make banks unprofitable or at least less stable, tax transaction (which has evasion written all over it), and one thing after another that pisses off some group of voters. Why not just simply tax everyone/? I get politicians want to pander to the middle class, whatever that is, but maybe everyone should pay for health care in a simple tax, since they all benefit from health care, and for most people it will be cheaper that the tax?

Separate from that, I know Sanders and his people have spent years dealing with single payor to derive their numbers. Is there some analysis out there why Sanders is so wrong on the numbers and Warren right/? it is easy to just say efficiencies, but anything we can read that says why Sanders is so wrong?

The problem politically is Warren has chosen a route to change all these different sectors of the economy or government without really addressing the reality of doing so, or the consequences of doing so, and wanting to do it all right now. Most countries have universal health care by charging a universal tax or fee to users. There are reasons for their simplicity. Maybe Warren is posturing and will be more pragmatic as a leader, assuming she can get elected. But the current leader promised a lot that people said can't structurally or practically happen, and he has not pivoted to reality.

---

I think your first paragraph greatly overstates the complications. Your third paragraph ignores the Medicare tax paid by everybody on a payroll that will continue to fund Medicare.

But I want to mostly comment on your second paragraph. I disagree that Sanders has spent years deriving their numbers. In fact, the Sanders numbers are very vague. Sanders has spent years talking about the generous benefits his plan would offer but has been rather quiet on costs and funding.

The main differences in costs between the Sanders and Warren plans come down to a few things:

Administrative costs. Private insurance currently runs about 12%, Sanders piggybacks on an Urban Institute study that assumes 6%, while Warren goes with the current Medicare cost of just over 2%. Administration is very scalable so with a bigger program there is no reason for its costs to go up as a percent of the total cost. If costs do go up on a percentage basis, they are doing it wrong.

Warren also scales in savings that Obamacare is achieving (inefficiencies around fee-for-service, as an example).

Warren also assumes 3.9% cost growth vs. Sanders 4.5% (also piggybacked from the Urban Institute's work, because the Sanders team didn't really put the work in).

dajo9 said:

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wifeisafurd said:

---

Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. The $20 trillion of funding over 10 years is potential sources of revenue. The actual price tag is about half that at $11 trillion over 10 years (Oaktownbear prefers $1.1 trillion annually). Immigration reform and many of the other funding mechanisms Warren lists are immaterial to the actual price tag, as I realized while answering Oaktownbear's post above. Warren should have probably kept it simple, showed fewer funding mechanisms and still easily covered the $11 trillion / 10 year price tag.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. We can pay for a new system with our current spending and lower costs and have more money at the end of the day. That is what inefficiency means. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

---

1. Yes it does. That doesn't mean it pays for healthcare. We have a $1.1 trillion dollar annual deficit and Trump is spending like it is going out of style. Saying you will roll back his ridiculous spending is a disingenuous way to find money. Hi honey. I know we haven't been able to make the mortgage payment. So I went out and bought a porsche for $100K. I then returned it. we now have $100K to spend on the mortgage.

2. This is not correct. By Warren's numbers, it will cost $20.4 Trillion over 10 years. No one believes her numbers. Studies from all political persuasions say $31 - 34 Trillion. She actually took a liberal study that said $31 trillion and said she could slash it by a third. She gets there with many extremely poor assumptions and by not factoring in potential consequences of the plan. For instance, she ignores the fact that if healthcare is free with no copays people will use more of it. (A great result, but a result that adds cost). She also gets there by enforcing lower payments to doctors and hospitals and assumes that there will be no impact to the number of doctors and hospitals from cutting their fees by a third. I know some doctors. Medical school and training is difficult and costly. People do it because they earn a lot of money. Drastically cutting their compensation will mean fewer people become doctors.

The $11 trillion is not the cost of the plan. It is the cost of telling everyone who currently pays health care premiums that they do not need to pay into the plan. I focused on that because it is this political pandering that makes the plan unworkable. If you have people continue to pay, as Bernie does, you can get there. If you do not, you can't

4. I'm sorry dajo, but I'm really surprised at you on the efficiency argument. This is every politicians answer to everything when they can't make numbers work. We'll drive efficiency.

The current Medicare payroll tax is a tiny amount taken out of your check your whole life to pay for health care in retirement. That money is already accounted for and it wouldn't come close to paying for lifelong healthcare. The $20.4 trillion dollars, or more realisticaly, $31-34trillion, is in addition to that. To be clear, the cost of providing healthcare to Americans, which Warren agrees with, is $52 trillion.

wifeisafurd said:

---

dajo9 said:

---

wifeisafurd said:

---

Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. The $20 trillion of funding over 10 years is potential sources of revenue. The actual price tag is about half that at $11 trillion over 10 years (Oaktownbear prefers $1.1 trillion annually). Immigration reform and many of the other funding mechanisms Warren lists are immaterial to the actual price tag, as I realized while answering Oaktownbear's post above. Warren should have probably kept it simple, showed fewer funding mechanisms and still easily covered the $11 trillion / 10 year price tag.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. We can pay for a new system with our current spending and lower costs and have more money at the end of the day. That is what inefficiency means. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

---

First, appreciate that in some ways you are preaching to the choir, we need universal care for a lot of reasons. My concern still is that the way Warren has chosen to do everything at once, and to fund the health program requires a constitutional amendment, a complete overall of the tax code, some way to cut military that is acceptable, change the way tax treaties are structured (which won't happen), forge an immigration agreement that on has been able to do, make banks unprofitable or at least less stable, tax transaction (which has evasion written all over it), and one thing after another that pisses off some group of voters. Why not just simply tax everyone/? I get politicians want to pander to the middle class, whatever that is, but maybe everyone should pay for health care in a simple tax, since they all benefit from health care, and for most people it will be cheaper that the tax?

Separate from that, I know Sanders and his people have spent years dealing with single payor to derive their numbers. Is there some analysis out there why Sanders is so wrong on the numbers and Warren right/? it is easy to just say efficiencies, but anything we can read that says why Sanders is so wrong?

The problem politically is Warren has chosen a route to change all these different sectors of the economy or government without really addressing the reality of doing so, or the consequences of doing so, and wanting to do it all right now. Most countries have universal health care by charging a universal tax or fee to users. There are reasons for their simplicity. Maybe Warren is posturing and will be more pragmatic as a leader, assuming she can get elected. But the current leader promised a lot that people said can't structurally or practically happen, and he has not pivoted to reality.

---

dajo9 said:

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wifeisafurd said:

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dajo9 said:

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wifeisafurd said:

---

Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. The $20 trillion of funding over 10 years is potential sources of revenue. The actual price tag is about half that at $11 trillion over 10 years (Oaktownbear prefers $1.1 trillion annually). Immigration reform and many of the other funding mechanisms Warren lists are immaterial to the actual price tag, as I realized while answering Oaktownbear's post above. Warren should have probably kept it simple, showed fewer funding mechanisms and still easily covered the $11 trillion / 10 year price tag.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. We can pay for a new system with our current spending and lower costs and have more money at the end of the day. That is what inefficiency means. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

---

First, appreciate that in some ways you are preaching to the choir, we need universal care for a lot of reasons. My concern still is that the way Warren has chosen to do everything at once, and to fund the health program requires a constitutional amendment, a complete overall of the tax code, some way to cut military that is acceptable, change the way tax treaties are structured (which won't happen), forge an immigration agreement that on has been able to do, make banks unprofitable or at least less stable, tax transaction (which has evasion written all over it), and one thing after another that pisses off some group of voters. Why not just simply tax everyone/? I get politicians want to pander to the middle class, whatever that is, but maybe everyone should pay for health care in a simple tax, since they all benefit from health care, and for most people it will be cheaper that the tax?

Separate from that, I know Sanders and his people have spent years dealing with single payor to derive their numbers. Is there some analysis out there why Sanders is so wrong on the numbers and Warren right/? it is easy to just say efficiencies, but anything we can read that says why Sanders is so wrong?

The problem politically is Warren has chosen a route to change all these different sectors of the economy or government without really addressing the reality of doing so, or the consequences of doing so, and wanting to do it all right now. Most countries have universal health care by charging a universal tax or fee to users. There are reasons for their simplicity. Maybe Warren is posturing and will be more pragmatic as a leader, assuming she can get elected. But the current leader promised a lot that people said can't structurally or practically happen, and he has not pivoted to reality.

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I think your first paragraph greatly overstates the complications. Your third paragraph ignores the Medicare tax paid by everybody on a payroll that will continue to fund Medicare.

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Please explain how? His first paragraph is an exact description of the complications.

With the wealth tax alone, it will face grave constitutional challenges. The INCOME tax was made possible by a constitutional amendment. She cites people that claim it is constitutional, but there is much dispute over that and THIS court is never going to buy it. Plus, even those that believe it could pass constitutional muster believe that any tax on real property would have to be apportioned to the state in which it was collected.

And then there is another issue with how she figures the benefits she can get out of the wealth tax. She takes a current estimate of the assets owned by billionaires and multiplies by the tax percentage. She assumes then that amount will be a perpetual revenue stream. She does not account for any reduction in tax avoidance techniques. Further, it is a policy (along with others she has) with a stated goal of diminishing billionaire's assets and creating less wealth disparity. Which I for one agree with. However, when that happens there will be less money subject to the tax and tax revenues go down. If tax revenues don't go down, the policy is a failure

That is one issue. All of his issues are correct.

Quote from the Washington Post:

Quote:

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The good news is, the math adds up, as long as you buy her assumptions. The bad news is that Warren's assumptions are crazier than keeping a pet rhinoceros, after which, who cares that her calculator works? This is to actual policymaking as the plastic noodles in a ramen-bar window is to lunch

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Look, the key point here is that you have two people that WANT single payer healthcare disputing not her healthcare plan, but how she intends to pay for it. I love the plan she wants to deliver. The way she says she will deliver it is ridiculous and she knows it. WIAF's summary statement is on point

Quote:

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I get politicians want to pander to the middle class, whatever that is, but maybe everyone should pay for health care in a simple tax, since they all benefit from health care, and for most people it will be cheaper that the tax

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She knows she won't pass her program so now she is just saying what the hell. I can promise whatever I want. It runs a real risk of turning people off of single payer as a solution.

wifeisafurd said:

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Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

WIAF

This is a great summary of just a small percentage of the problems with the gymnastics she goes through to claim she can fund the plan with no funding from the middle class. She is banking on no one getting into the weeds on her plan, her supporters drilling everyone who challenges her, and never being able to pass any of it and then blaming others for the failure of her great plan. The primary statement of what is wrong with this pander is

Quote:

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As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic

---

The stink of this plan will be rubbed all over every good single payer plan that has been proposed or will be proposed. But if it gets her the presidency, who cares.

It would have been more realistic if she just promised Mexico would pay for it.

wifeisafurd said:

---

dajo9 said:

---

wifeisafurd said:

---

Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

---

I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. The $20 trillion of funding over 10 years is potential sources of revenue. The actual price tag is about half that at $11 trillion over 10 years (Oaktownbear prefers $1.1 trillion annually). Immigration reform and many of the other funding mechanisms Warren lists are immaterial to the actual price tag, as I realized while answering Oaktownbear's post above. Warren should have probably kept it simple, showed fewer funding mechanisms and still easily covered the $11 trillion / 10 year price tag.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. We can pay for a new system with our current spending and lower costs and have more money at the end of the day. That is what inefficiency means. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

---

First, appreciate that in some ways you are preaching to the choir, we need universal care for a lot of reasons. My concern still is that the way Warren has chosen to do everything at once, and to fund the health program requires a constitutional amendment, a complete overall of the tax code, some way to cut military that is acceptable, change the way tax treaties are structured (which won't happen), forge an immigration agreement that on has been able to do, make banks unprofitable or at least less stable, tax transaction (which has evasion written all over it), and one thing after another that pisses off some group of voters. Why not just simply tax everyone/? I get politicians want to pander to the middle class, whatever that is, but maybe everyone should pay for health care in a simple tax, since they all benefit from health care, and for most people it will be cheaper that the tax?

Separate from that, I know Sanders and his people have spent years dealing with single payor to derive their numbers. Is there some analysis out there why Sanders is so wrong on the numbers and Warren right/? it is easy to just say efficiencies, but anything we can read that says why Sanders is so wrong?

The problem politically is Warren has chosen a route to change all these different sectors of the economy or government without really addressing the reality of doing so, or the consequences of doing so, and wanting to do it all right now. Most countries have universal health care by charging a universal tax or fee to users. There are reasons for their simplicity. Maybe Warren is posturing and will be more pragmatic as a leader, assuming she can get elected. But the current leader promised a lot that people said can't structurally or practically happen, and he has not pivoted to reality.

---

Sanders, discussing his plan this weekend in contrast to hers:

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"I'm not going to say that it is free, nothing is free, health care is expensive," Sanders said at a town hall in Cedar Rapids, Iowa, on Saturday.

"The average American will pay substantially less for health care than he or she is paying right now. Yes you will pay more, depending on your income, we exempt the first 29,000 dollars from taxation," he said, wading into specific details on his taxation plan he usually doesn't mention.

"I think we have a better way, which is a 7.5% payroll tax, which is far more I think progressive, because it'll not impact employers of low wage workers but hit significantly employers of upper income people

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I'm no Bernie Bro, but he is at least honest.

OaktownBear said:

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dajo9 said:

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wifeisafurd said:

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Two cents from the non-liberal, who is on Medicare. This is the only major developed country without a national medical system. Obamacare no matter how well intended is failing, and not just because the current administration has taken actions to ultimately kill it. There is no perfect medical system, the idea is to have the most winners and not unduly burden the economy with something too expensive.

My preference was the phased plan to extend Medicare being pushed by Harris, who is rapidly marking time before she now longer is a candidate for President. My view is a single payer system is needed. When a single system of universal health care is in place, the government is able to leverage the size of the medical market to negotiate better pricing structures. That lowers the cost of care because services and medication tend to be lower (may feel medicare is not doing that great on the meds side). Health care spending, as a portion of the GDP, goes down. You will not hear Sanders, Warren or others say this because it sounds rather cold, but this is a legitimate argument to change the current system.

Medicare for all reduces administrative costs, simplifies rules (some say arbitrarily), and should, in theory, provide greater access. So as an alternative to the current system, it has benefits.

There are negatives. In the United States, about 5% of people consume about 50% of the health care costs which are generated each year. On the other end of the spectrum, the healthiest 50% of the population consumes just 3% of the health care costs in the country. In a system of universal health care, those who are healthy and wealthy are asked to care for those who are poor and sick. That can be difficult to accept since many chronic diseases can be prevented with simple lifestyle modifications, but people don't want the government to play mommy, and tell us what to do. Doctors and some hospitals make a lot of money in a free-market system of health care when they are able to provide needed services to patients who require them. Within a system of single payer system with cost controls, doctors are often assigned more patients, there may be longer waits fro heath care until the number of health professionals increase to meet demand, and care for some at the top or bottom (where subsidized) of the income spectrum may drop. It may also limit services, as some doctors may not feel they earn enough given their liability risk. Also, as some Canadian provinces found, if you don't manage the cost control well, costs sky rocket with full access to medical care, the costs of health care can be as much as 40% of the government's annual budget at the provincial level, which reduces services in other areas, lie for education, infrastructure and other social needs. I feel most of this could be eliminated by sharing risks with insurance companies that provide medicare supplemental coverage and a ramp-up that are in the Harris approach.

That said, what Warren is proposing in terms of benefits represents a step in the right direction IMO. The issue is paying for it since it so ambitious, so quickly, rather than the ramp-up most medicare for all proponents are suggesting.

The first criticism is that she underestimates the cost. For example, Sanders says it will cost $30 Trillion, but Warren only is raising around $20 Trillion, and saying with a slight of hand, administrative savings, strong tax enforcement, etc. will make up the difference. A 1/3 of your total budget bet on savings and tax enforcement doesn't meet the eyeball test. I think Sanders has a more realistic view. I simply don't think other countries that went to single payor saw this level of savings, though I'm willing to be proved wrong.

Then there is Warren plans completely rearranges the entire banking/economy, heath care, budget and military system ALL AT ONCE! Starting from the back:

1) What does an $800 billion cut in defense means? What national security concerns does it raise? What moderate Democrat or Democrat with military facilities in his or her district is going to sign on to this?

2) On the budget, she is relying on promises wholesale immigration reform (good luck with that) to generate hundreds of billions of dollars, a reduction in money going to state and local governments (that might happen, though won't go over well in budget strapped Cali), and then there is the budget busting impact. Her plan's $20.5 trillion price tag is equal to roughly one-third of what the federal government is currently projected to spend over the next decade, in total. Part of the problem is Warren's competitors will scare voters from plunging into a "socialist" abyss of red ink. What is going to pay for the rest of the progressive platform? After Trump, maybe voters have become a bit too savvy to think you can have everything?

3) A lot of people like their health insurance, particularly those of us on Medicare when it comes to our supplemental insurance. At least in Medicare, they hammer doctors who get out of line or cheat, and actually seem to look out for our interests (unlike my former firm's private insurer who seems to want to screw me at every opportunity).Warren doesn't seem to consider the downsides from slashed reimbursement (doctors and nurses pay?), elimination of private insurance companies (jobs for all those white-collar workers?) and/or mammoth tax hikes (growth? jobs?), failing hospitals, etc. This embodies one of the major criticisms of the super-progressive wing of the Democratic Party: blind faith in centralized federal government with little or no regard for unintended consequences on the economy.

4) What exactly does her changes to the tax codes mean? Conceptually a wealth tax seems smarter than an income tax - why be punitive to people who arguably are productive than that those who hold assets? But why don't countries do it (or at least do it with most assets). A net-wealth tax requires a reliable estimate of net wealth. Valuation of illiquid assets, like privately held companies, is absurdly complex. Warren may hire a legion of IRS employees (possibly all the unemployed insurance company employees) to evaluate assets, but since value is ultimately subjective, there is no guarantee enforcement will be uniform and not meet with major push back. And then there is the question as to what assets do I really have or enjoy, Do I get taxed on my free use of Google products since it represents value and enhances my wealth? Oh and she needs to get an immediate constitional amendment. While the Sixteenth Amendment abolished this requirement for income taxes, wealth taxes are never mentioned. There is a reason they needed that amendment (the Constitution says taxes have to be proportional to population, and that isn't the case with wealth, and states like California will be unconstitutionally burdened). Also she has to change a lot of treaties, which don't allow the US to tax assets abroad (and other counties can't go after assets in our country). The rich have much of their assets off-shore (like patents). Then there are economic impacts. Capital is taken out of circulation. High wealth people disproportionately invest their wealth in both money making and charitable enterprise, which fuel for long-term projects in both areas. The American economy would eventually become less dynamic and competitive as a result. Then there is the ability to pay. Are you now insisting the people have to liquidate appreciated assets to pay taxes? The wealthiest tend to own business assets that produce economic growth, and forcing their owners to sell them to pay taxes could hurt growth. I'm not sure I fully understand the transaction tax, but in current form, it looks regressive.

What Warren proposes is massive changes that will aggravate many different classes of voters and even many different Democratic constituents. As someone who has constantly been a supporter of a single payor system , I hope she has not doomed the concept by being so unrealistic. At least with Sanders, I know what I getting, all of us income taxpayers pay for medical coverage. This has been used by developing countries like Britain for years, without causing massive upheavals in the rest of the country affairs, like I think will happen with Warrren's plan. , We don't need to change the Constitution, military budget, treaties, way of collecting taxes, state budgets, and our economy to do it, We just have to say to people you have to pay taxes for health care. All of us.

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I added a couple of bolds on my own to highlight my points as I address the issues you raise.

Underestimated costs - You actually answered your own issue here. You begin by pointing out that singlepayer health care has large efficiencies that will reduce spending percent of gdp and administrative costs. You add that Warren won't say this. Actually Warren does say this. She builds it into her plan. It's why her assumed costs are lower. What you call underestimated costs but actually you explained in the beginning of your post.

Your numbered concerns from above:
1. $800 billion over 10 years or $80 billion / annually. That means we roll back last year's defense spending increase. This needs to be done regardless of health insurance.
2. The $20 trillion of funding over 10 years is potential sources of revenue. The actual price tag is about half that at $11 trillion over 10 years (Oaktownbear prefers $1.1 trillion annually). Immigration reform and many of the other funding mechanisms Warren lists are immaterial to the actual price tag, as I realized while answering Oaktownbear's post above. Warren should have probably kept it simple, showed fewer funding mechanisms and still easily covered the $11 trillion / 10 year price tag.
3. I think you answered your own concern in the part I bolded
4. The more I look at Warren's plan the more reasonable it becomes to me. The core is how inefficient and awful our current system is. We can pay for a new system with our current spending and lower costs and have more money at the end of the day. That is what inefficiency means. And for those of you concerned that there won't be a tax that everyone pays into - there will be. It's called the Medicare payroll tax. It is there right now and it will continued to be there. Everybody pays into the system.

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1. Yes it does. That doesn't mean it pays for healthcare. We have a $1.1 trillion dollar annual deficit and Trump is spending like it is going out of style. Saying you will roll back his ridiculous spending is a disingenuous way to find money. Hi honey. I know we haven't been able to make the mortgage payment. So I went out and bought a porsche for $100K. I then returned it. we now have $100K to spend on the mortgage.

2. This is not correct. By Warren's numbers, it will cost $20.4 Trillion over 10 years. No one believes her numbers. Studies from all political persuasions say $31 - 34 Trillion. She actually took a liberal study that said $31 trillion and said she could slash it by a third. She gets there with many extremely poor assumptions and by not factoring in potential consequences of the plan. For instance, she ignores the fact that if healthcare is free with no copays people will use more of it. (A great result, but a result that adds cost). She also gets there by enforcing lower payments to doctors and hospitals and assumes that there will be no impact to the number of doctors and hospitals from cutting their fees by a third. I know some doctors. Medical school and training is difficult and costly. People do it because they earn a lot of money. Drastically cutting their compensation will mean fewer people become doctors.

The $11 trillion is not the cost of the plan. It is the cost of telling everyone who currently pays health care premiums that they do not need to pay into the plan. I focused on that because it is this political pandering that makes the plan unworkable. If you have people continue to pay, as Bernie does, you can get there. If you do not, you can't

4. I'm sorry dajo, but I'm really surprised at you on the efficiency argument. This is every politicians answer to everything when they can't make numbers work. We'll drive efficiency.

The current Medicare payroll tax is a tiny amount taken out of your check your whole life to pay for health care in retirement. That money is already accounted for and it wouldn't come close to paying for lifelong healthcare. The $20.4 trillion dollars, or more realisticaly, $31-34trillion, is in addition to that. To be clear, the cost of providing healthcare to Americans, which Warren agrees with, is $52 trillion.

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On #2 you are correct that what I said is incorrect. Your focus on $11 trillion and my quick read of an article got me mixed up. When I get a chance I'll go back up and delete some of the inaccurate things I wrote above.

I addressed the difference in costs you raise in my reply to wiaf. Due to the fee-for-service system some doctors are overpaid (specialists) and some doctors are underpaid (generalists, pediatricians). I would agree with you that any cuts to salaries to generalists and pediatricians would be ill advised. The current system has caused a shortage of them anyway.

On #4 I am surprised that you are surprised by efficiency arguments. I've been complaining about the inefficiencies of the health care system on these boards since I began posting here. Since way before Bernie Sanders was a national figure. If we can't make it more efficient then why bother? Just keep the current system.

dajo9 said:

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LudwigsFountain said:

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I spent my entire career in health care finance and I'll stipulate that there's plenty wrong with the current system, but I'm terrified of Medicare for all primarily for a single reason -- fee-for-service Medicare does not have an effective utilization review system.

For about five years I was in charge of hospital-physician joint venture that provided service to roughly 12,000 Medicare beneficiaries. They were split almost evenly between traditional government fee-for-service Medicare and a private insurance plan that paid us a fixed amount per month. The two populations were essentially demographically identical. The physicians were skeptical of the private plan, so to get them on board, the hospital agreed that their portion of the fixed payment would leave them no worse off than if they had received Medicare payments for their treatment of the plan's patients. What we found was that the fee-for-service population's cost ran about 20% more than the fixed payment group, with no discernible difference in outcomes. And this was with no fraud involved, which is a big issue with Medicare. This reinforced all my other (admittedly anecdotal) experience with Medicare.

In other words, I think Medicare is actually far less efficient than private insurance and as a result Medicare for all will prove far more costly than any of the plans put forward predict

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Fee for service is an inefficiency of the current system both in Medicare and private insurance. Legislation has been passed to address this challenging issue going back to the GWB administration, Obamacare, and it is addressed in every plan out forward (Warren, Sanders, etc.).

It's a challenge, no doubt but not a challenge solely of Medicare. The vast majority of private insurance pays fee for service.

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What I should have added is that private insurance has a strong incentive to deny unnecessary care and prohibit costly practices such as 'upcoming', and does a much, much better job in those realms than Medicare. I believe that's because the Medicare bureaucracy has little incentive for such activity. Medicare got somewhat better in this arena over my time, and maybe it's doing even better now, but there was just an enormous gap in my experience.

Also, any Medicare for all plan should address the current unfunded liability that Medicare bears and take paying for that liability into account when putting forth a cost estimate. The annual trustee's report on Medicare pegs the deficit at around $40 trillion and many (including me) believe that number is optimistic.

Finally, I think relying on reducing payments to Medicare's level is wishful thinking. I'm a believer in regulatory capture and I think Medicare is a prime example. In very, very simple terms we spend more of our GDP on healthcare because we provide more of it and pay our providers substantially more than other countries. I think it's extremely instructive to look at our spending over time. As a percent of GDP it was stable throughout the 20th century until the advent of Medicare and Medicaid in 1966 and then started growing steadily. I just don't believe we can reverse that with legislation; there's too much vested interest in keeping the funds flowing.

Since Bernie and Warren's health care plans are dead on arrival, the question is will they be willing to compromise to an add-on features to obamacare like the public option.

LudwigsFountain said:

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dajo9 said:

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LudwigsFountain said:

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I spent my entire career in health care finance and I'll stipulate that there's plenty wrong with the current system, but I'm terrified of Medicare for all primarily for a single reason -- fee-for-service Medicare does not have an effective utilization review system.

For about five years I was in charge of hospital-physician joint venture that provided service to roughly 12,000 Medicare beneficiaries. They were split almost evenly between traditional government fee-for-service Medicare and a private insurance plan that paid us a fixed amount per month. The two populations were essentially demographically identical. The physicians were skeptical of the private plan, so to get them on board, the hospital agreed that their portion of the fixed payment would leave them no worse off than if they had received Medicare payments for their treatment of the plan's patients. What we found was that the fee-for-service population's cost ran about 20% more than the fixed payment group, with no discernible difference in outcomes. And this was with no fraud involved, which is a big issue with Medicare. This reinforced all my other (admittedly anecdotal) experience with Medicare.

In other words, I think Medicare is actually far less efficient than private insurance and as a result Medicare for all will prove far more costly than any of the plans put forward predict

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Fee for service is an inefficiency of the current system both in Medicare and private insurance. Legislation has been passed to address this challenging issue going back to the GWB administration, Obamacare, and it is addressed in every plan out forward (Warren, Sanders, etc.).

It's a challenge, no doubt but not a challenge solely of Medicare. The vast majority of private insurance pays fee for service.

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What I should have added is that private insurance has a strong incentive to deny unnecessary care and prohibit costly practices such as 'upcoming', and does a much, much better job in those realms than Medicare. I believe that's because the Medicare bureaucracy has little incentive for such activity. Medicare got somewhat better in this arena over my time, and maybe it's doing even better now, but there was just an enormous gap in my experience.

Also, any Medicare for all plan should address the current unfunded liability that Medicare bears and take paying for that liability into account when putting forth a cost estimate. The annual trustee's report on Medicare pegs the deficit at around $40 trillion and many (including me) believe that number is optimistic.

Finally, I think relying on reducing payments to Medicare's level is wishful thinking. I'm a believer in regulatory capture and I think Medicare is a prime example. In very, very simple terms we spend more of our GDP on healthcare because we provide more of it and pay our providers substantially more than other countries. I think it's extremely instructive to look at our spending over time. As a percent of GDP it was stable throughout the 20th century until the advent of Medicare and Medicaid in 1966 and then started growing steadily. I just don't believe we can reverse that with legislation; there's too much vested interest in keeping the funds flowing.

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The private sector spends a lot of money to deny care, both necessary and unnecessary. They make money by denying care. It's their business model. For example, when my Aunt came down with leukemia, her private insurer tried to drop her. While my Aunt was on the verge of death (since recovered) her sister spent hours on the phone arguing with the insurance company. That is not the kind of health insurance coverage America needs.

Also, blaming the increase in costs in America on medicare and medicaid is completely counter-intuitive. Medicare and medicaid are the closest thing America has to what every other advanced country has (except maybe the VA). Other countries don't have the cost increases and poor outcomes since the 1960's that America has. Only American ha those poor results and only America has a primarily private based insurance system.

I'm sorry for you aunt's experience; as I said there's plenty wrong with our system.

As far as the role of Medicare and Medicaid in our cost increases, I think you have to look at their payment mechanism in contrast to those of other country's health systems. Other countries employ physicians and operate hospitals, which gives them a direct method of controlling compensation and utilization; our system doesn't. We can lower payment rates, but have to buck the AMA and pretty powerful nurse unions. I don't think the other countries have such entrenched interests. Or at least such politically successful interests.

I don't at all mean to be quarrelsome here; I'd like to understand why you have such faith that a system that is so clearly financially unsustainable in its current form can be extended to the entire population and work out financially. Let's make the optimistic assumption that transforming the corporate payments for private plans into a tax successfully funds the under 65 population in the Medicare system. How do we address the enormous deficit for the over 65 cohort without substantially raising taxes beyond what the proposed solutions predict? BTW I don't think the answer is lower overhead. Medicare is often touted for having a 4% overhead burden much lower than the number for private plans. But those calculations are made on the basis of provider payments and expenditures for Medicare beneficiaries run four to five times as much as those for private plans. In my experience a more appropriate way to state overhead costs is on a per capita basis, which puts Medicare right in line with private plans, if not higher.

And I feel I have to address the outcomes issue. We have worse outcomes for certain metrics (and much better ones for others) but if you dig into the 'bad' outcomes I think you find that the health care system isn't the problem. I'll address two - life expectancy and infant mortality. If you eliminate the difference in auto fatalities and murder, you reduce much of the difference. Big problems but not related to healthcare. I'd bet (but can't back it up) that most of the remaining reflects the cultural difference in lifestyle choices. For example the rate of type 2 diabetes in the US is a little more than double that of most other developed nations.

As to infant mortality, it's important to understand that one of the most critical factors in infant survival is birth weight and we have far more premature births than other countries mostly related to drug abuse. If you look at survival rates by birth weight we rank first. In addition a lot of countries don't include infant deaths in their stats unless the infant survives two or three days.

Anyway, I appreciate the discussion because I care about the healthcare system a lot and think it needs substantial change but have a deep-seated fear that a Medicare for all approach will have a profoundly negative impact, despite the intentions of those who are behind it.