What Warren should say about Medicare for All

This is from The New American Prospect:

October 22, 2019

Meyerson on TAP

How Elizabeth Warren Can Address the Medicare for All Question. Elizabeth Warren is now dotting the i’s and crossing the t’s on her own Medicare for All plan, which she has pledged to release shortly. As David Dayen astutely notes today, the plans put forth by Warren’s and Bernie Sanders’s primary opponents—chiefly, Joe Biden and Pete Buttigieg—will, if they’re any good, end up costing about as much as the Medicare for All proposals they’ve disparaged.

B&B’s emphasis on the taxes that will fund Medicare for All (and, not that they admit it, their own plans, too) misses the fact that the great majority of Americans pay far more for their private insurance than they would in higher taxes, though what they pay now is largely concealed from them because their employer routinely takes it out of their pay. (Of course, if we do go to Medicare for All, workers will have to fight to compel their bosses to transfer the savings to them, rather than divert it into dividends and buybacks.)

How can Elizabeth Warren address the major savings workers can win by shifting to Medicare for All? My friend Steve Tarzynski, who’s president of the California Physicians Alliance, suggests something like the following:

Right now, you and your family pay $18,000 a year in premiums for employer-sponsored insurance that doesn’t even cover everything and that you could lose at any time. Plus another $2,000 in deductibles before it even kicks in and another $1,000 in co-pays. That’s about $21,000 every year for a basically defective product. That’s the “private tax” you’re paying right now. And your choice of doctor is restricted and you can even lose access to your doctor at any time. All that would go away with Medicare for All—no more premiums, no more deductibles, and no more co-pays. And all the care you and your family need will be covered and can never be taken away. You can choose any doctor you want. Yes. You’ll pay $5,000 more in taxes for all of that. But it will put $16,000 back in your pocket. And it doesn’t even include the share of the premium that your employer pays now that you could get back in wages and salary. Would you settle for that?

And to my fellow Democrats on the stage here who oppose Medicare for All, who are you really working for? Because what you propose is exactly what the insurance industry wants.

That’s so good I got nothing to add. Would work not just for Warren but for Bernie, too. ~ HAROLD MEYERSON

The Cost of Medicare for All

Both Elizabeth Warren and Bernie Sanders have come out as favoring "Medicare for All" as the only healthcare plan for America they support. Neither has given a definite figure for the costs; Warren has been cagey and Sanders does not deny a figure in the $30 trillion dollar range. 

The claim (by both Sanders and Warren) that fails to be emphasized is the net cost to Americans: While their taxes will certainly go up (you can't get something for nothing), their total out-of-pocket expenses may very well go down, since they will pay no premiums and have no deductibles. The media, in its need to create controversy and "gotcha" moments, keep insisting that the candidates talk first about the increase in federal taxes. Maybe this is an attempt to bring up some sort of anti-government feeling in the electorate. It is unfortunate that this conservative attitude has been allowed to grow. The Democrats a long time ago should have pointed out that the government is our government -- we have a direct say in what it does and a constitution that codifies this say; this is opposed to our direct say in what private entities like corporations do, which is nil.  (Why don't our kids learn this in school? Answer: because right-wingers have eliminated or emasculated "civics" courses where we used to learn about our government, how we direct it, and how it protects us.)

Of course, the belief that current premiums and deductibles are greater (in dollars) than the (projected) increase in federal middle-class taxes under Medicare for All has itself has not been definitely established. Bernie points out that similar programs in other countries have produced medical care that is at least as good as what we have now, but at half the cost. This argument itself has been attacked (see below).

A lot of the cost estimates are discussed in a fairly long Politifact article which can be found HERE.

What has happened in other countries is not necessarily a foretaste of what will happen here. First of all, not all other countries that have universal healthcare (and that is pretty much all developed counties except the US) have a Medicare for All system -- some, like France, have a very good hybrid system with both public and private insurers. Secondly, drug expenses may be lower in other countries because of the simple fact that they are high in the US. Big Pharma still makes enough profit here so that they can charge less there. Also, the financial culture of doctors and hospitals in other countries is different from ours: Here doctors pay a lot for their education and consequently expect to get paid a lot after they become credentialed (they've been told this for decades by their peers and their guild, the AMA). Hospitals here have a different style of ordering and paying for tests and using doctors (and nurses) and charging for rooms; this "style" is the result of the influence of Big Pharma, the medical device industry, and doctors themselves who are often associated financially with these industries (e.g. many doctors have interests in medical scanning and testing businesses). These things will all have to change in order to bring down the costs of healthcare here, and it will not be easy. 

(In response to questions from both the media and other Democratic presidential candidates, Elizabeth Warren has  announced that she will publish her plan for Medicare for All, including proposed finances. She obviously has to be careful since everyone will be ready to pounce on her inevitable use of increased taxes.)