“You don’t get what you don’t fight for,” says Senator Elizabeth Warren in her 9,300-word, 165-hyperlink proposal to extend Medicare to all Americans.
Those 165 hyperlinks aren’t the only reason I’ll fight for Warren’s plan to make sure no American family is bankrupted by illness or injury again, but they represent the vast improvement we would make if we returned to electing a President who can back her arguments with evidence, lots of evidence. The current occupant of the White House speaks in tweets and grunts; Elizabeth Warren speaks in paragraphs and footnotes.
Warren also speaks in empathy. She opens her policy proposal with these words:
My daddy’s heart attack nearly sent our family skidding over a financial cliff. Today I think about all the kids this year who will face the double blow of nearly losing a parent and then watching their lives turn upside down as their families struggle to pay a growing stack of medical bills [Sen. Elizabeth Warren, “Ending the Stranglehold of Health Care Costs on American Families,” ElizabethWarren.com, posted 2019.11.01, retrieved 2019.11.03].
Warren tell us her story, in one sentence, to tell us she understands ours. In the four long, dreary years since Donald Trump launched his campaign for the job he now fails to do daily, he has not uttered a single sentence like this that suggests he understands the real struggles of regular Americans.
Warren quickly turns to the data that backs her story, data she has spent her career gathering (again, the kind of sentence the current occupant of the White House cannot honestly utter):
I spent my career studying why so many hard-working middle class families were going broke. For years, my research partners and I traveled the country from bankruptcy courtroom to bankruptcy courtroom, talking directly to people who’d seen their lives turned upside down. We interviewed lawyers, judges, and families involved in bankruptcy cases. To save on printing costs, we lugged around a Xerox machine (I nicknamed him “R2-D2”) to save money on photocopying court records.
Eventually, we built the largest and most comprehensive database of consumer bankruptcy data ever assembled. That first study surprised us: we found that 90% of families went bankrupt because of job loss, medical problems, and marital disruption. That finding was confirmed in 2007 by my later research, which found that the number one reason families were going broke was health care – and three quarters of those who declared bankruptcy after an illness were people who already had health insurance [Warren, 2019.11.01].
The problem persists. Even with the expansion of health insurance coverage brought by the Affordable Care Act (progress now maliciously reversed by the current Administration), Warren says 87 million Americans are uninsured or underinsured. 57 million are pinched by medical bills. 37 million skipped prescriptions, 36 million skipped tests or treatments or follow-ups, and 40 million declined to take a health problem to the doctor because of cost.
Warren says “the wealthiest nation in the world” should not have “inadequate health coverage… crushing the finances and ruining the lives of tens of millions of people.” Unlike the selfish oaf in the White House, Warren believes in America, and believes America can do better.
Warren proposes Medicare for All to make America better. She bases her plan on two core values that she defies any opponent to challenge:
All my plans start with our shared values. There are two absolute non-negotiables when it comes to health care:
One: No American should ever, ever die or go bankrupt because of health care costs. No more GoFundMe campaigns to pay for care. No more rationing insulin. No more choosing between medicine and groceries.
Two: Every American should be able to see the doctors they need and get their recommended treatments, without having to figure out who is in-network. No for-profit insurance company should be able to stop anyone from seeing the expert or getting the treatment they need.
Health care is a human right, and we need a system that reflects our values. That system is Medicare for All [Warren, 2019.11.01].
Warren’s statement of values is brilliant campaign craftswomanship. The body of her proposal is chock full of numbers and nitty-gritty (not that that’s a bad thing!), but these two core principles are immediately comprehensible, especially to anyone who has had a major medical procedure. and utterly irrefutable, at least to anyone who wants not to be booed off a campaign stage. If you don’t agree with those two values, you shouldn’t be President.
Warren uses these values to put opponents in a corner:
Every candidate who opposes my long-term goal of Medicare for All should explain why the “choice” of private insurance plans is more important than being able to choose the doctor that’s best for you without worrying about whether they are in-network or not. Why it’s more important than being able to choose the right prescription drug for you without worrying about massive differences in copays. Why it’s more important than being able to choose to start a small business or choose the job you want without worrying about where your health care coverage will be coming from and how much it will cost [Warren, 2019.11.01].
“Choosing” a private health insurance policy that proceeds to take our money, limit our medical choices, and look for ways to not pay for our health care is not real liberty. Choosing our medical and professional paths freely, without the interference of opaque insurance policies or the fear of medical bankruptcy is the much greater liberty offered by a plan like Warren’s for universal health coverage. Anyone opposed to Warren’s plan who doesn’t offer a counterplan has to explain why more practical liberty is bad.
That doesn’t mean one can’t argue against Warren’s plan. Is it just? is off the table, but Will it work? and Will it pass? remain.
Warren says she can make it work with no net increase in spending on health care. The projected price tag for every medical bill in America over the next ten years is $52 trillion. Warren says she can cover more Americans (all Americans!) with more reliable and comprehensive (long-term care, hearing, vision, dental, mental) coverage for the same amount, if not a few dollars less. To get more without spending more, Warren machine needs a lot of moving parts:
- Save money on administrative costs: no more hassle for health care providers dealing with diverse insurers, and no more replication of functions and high CEO pay among those myriad for-profit insurers.
- Reduce costs for medical procedures as Uncle Sam reimburses every hospital for every patient’s procedures at 110% of Medicare rates (with higher reimbursements for rural hospitals).
- Increase competition in health care by cracking down on “anti-competitive mergers that lead to worse outcomes and higher costs for rural communities” (hey! Rural voters! That’s two planks in a row where Warren is offering you more than Trump has!).
- Increase competition by giving patients more freedom to shop around for doctors without private insurers’ network restrictions.
- Bundling payments à la the Affordable Care Act to pay by the medical “episode” (which Warren says has “been shown to both improve outcomes and control costs“) instead of paying for more services.
- Cap reimbursement for prescription drugs at 110% of the average international market price and negotiate for lower prices.
- Override patents and subsidize manufacture of essential drugs if drugmakers won’t play ball.
- Redirect the $6 trillion states spend on Medicaid and public employee health insurance to Medicare for All.
- Redirect most (Warren sets the initial rate at 98%) of what employers pay for private insurance to taxes to support Medicare for All.
- Rebuild the IRS to reduce tax evasion and fraud (“The Treasury Department estimated in its Fiscal Year 2017 budget request that every $1 invested in IRS enforcement brings in nearly $6 in additional revenue – not even including an indirect deterrence effect three times that amount.”)
- Reform immigration (“including a pathway to citizenship for undocumented immigrants and expanded legal immigration”) to put more workers on the books paying taxes.
- Repeal the Overseas Contingency Operations fund that has become a slush fund for the Pentagon.
- Tax financial transactions, large corporations, and billionaires.
In return for those reforms, out-of-pocket expenses for regular Americans goes from $11 trillion to “practically zero.” That’s over a trillion dollars a year in economic stimulus, money that Joe and Jane Six-Pack would otherwise throw at insurance premiums and medical bills that now goes mostly toward consumer spending, with a little boost to federal revenues as we pay taxes on that additional take-home pay.
Warren’s plan is impressive in its reach. It shows that she views problems in their full, complex context. She uses the Employer Medicare Contribution rates of the transition period into Medicare for All to promote unionization to strengthen the middle class with collective bargaining and higher wages. She notes that shifting the burden of health benefits from employers to medicare removes the competitive disadvantage small businesses face in recruiting talent against big corporations that can offer more generous benefits. She simplifies the tax code by eliminating the need for medical savings accounts and medical expense deductions. She undoes the rigging rich tax cheats have used to hamstring the IRS and avoid paying their fair share. She reforms immigration and military spending and repeals costly and failed elements of the Trump tax cuts. Elizabeth Warren knows that solving real problems takes more than tweets (“We need plans, not slogans”). Warren sees the big picture and pulls all the pieces together into one big, bold plan.
In this one plan, Elizabeth Warren tells us more about how health care and the economy work and how they could work than Donald Trump has tweeted or bleated in the last four years. Even if you think you have a better plan for national health insurance, you should still elect Elizabeth Warren to do your math and run your plan and explain it to everyone because she’s that smart!
Of course, one could argue that if Warren were smart, she wouldn’t propose an $11-trillion redistribution of wealth to an electorate easily swayed by fascist sloganeering about Socialism! But Warren isn’t worried about campaign-tactic smarts. Warren offers problem-solving smarts. Yes, her Medicare for All transfers wealth. Warren’s Medicare for All moves $11 trillion from a few hands where it’s not doing much good to far more hands to make America healthier and rebuild the middle class. Making people see past the easy slogans the inscrupulous right wing and corporate profiteers will throw at the plan will require a huge fight. But Warren invites that fight:
…there’s a reason former President Barack Obama has called Medicare for All a good idea. There’s a reason the American people support it. It’s because when it comes to the cost of health care, we are in the middle of a full-blown crisis.
We are paying twice as much as any other major nation for care – even as tens of millions lack coverage, and even as family after family sees its finances destroyed by a health issue. And the American people know that in the long-term, a simple system that covers everybody, provides the care they need when they need it, puts $11 trillion back in their pockets and uses all of the public’s leverage to keep costs as low as possible is the best option for their family budgets and for the health of their loved ones.
As President, I’ll fight to get it done [Warren, 2019.11.01].
Medicare for All was a good idea when George McGovern called for it ten years ago. Senator Warren’s iteration of that proposal is a more instructive, rational, comprehensive, and humane plan than anything offered by the incumbent. Medicare for All is worth fighting for now… as is Warren’s style of campaigning as problem-solver- and teacher-in-chief.
I like Medicare For All, but it ain’t happening. As an aspirational goal, I’m all in for it. If I had a vote in Congress, I’d vote for it. As a practical matter, it has no chance of actually being enacted. There aren’t enough people like me and you likely to be in the Senate in the next Congress.
One thing I hate is pandering politicians who put out pie-in-the-sky proposals that have no chance of being enacted. Medicare For All is progressives’ “Big, Beautiful Wall.” Hey, wake up from your wet dream. It ain’t happening.
Awake now? Let’s get down to reality. Maybe, just maybe, the next Democratic President can get a public option, but the very least he or she could accomplish is to dismantle all the Republican hurdles and roadblocks to Obamacare, and to fix what needs fixing with that program.
I’m aware of all the problems with private health insurance. My experience with my employers’ plans was generally good, however, and that’s replicated all over the swing states in the Rust Belt, where unions and progressive HMOs worked together to build good health care. Democrats can’t win in Wisconsin, Michigan and Pennsylvania by tearing down what has been built.
Good summary, Cory.
I’ve always been “insured” by a single payer system. As a military officer, retiree and now Medicare/Tricare.
My cancer bills totaled nearly $400K. My late wife’s AVM (the same thing that struck Sen Tim Johnson) cost $250K and would have gone through the ceiling had she not been allowed to die with dignity.
At no time have I ever had to worry about the standard of quality of the care I or my family has received.
This isn’t “Socialism,” it’s humanity.
There is no reason why a universal 3% of gross income charge on everyone cannot fund the system; and if “corporations are people,” same contribution.
Sen Warren is right. Unfortunately, she is an intelligent woman and it’s quite apparent what the establishment thinks on that matter. This, sadly, makes her chances of election rather slim.
Buckobear, spot on. I am not a retiree from the military but instead medically retired due to wounds. I’ve been covered under the military and VA since 1968. In that time, I’ve had various serious issues that have taken care of very effectively and professionally by all involved. This isn’t Socialism, this is humanity to take care of our fellow man.
With Medicare, presently, you pay about $135.00 a month for the Part B. If that were to be changed to the 3% of gross income, we could not only have Medicare for all, we could do what the ACA was supposed to do and guarantee medical school for those who would serve areas like South Dakota’s rural areas. Booyah!
We can more than afford this….but Warren is a Women…so there’s that.
Of course Medicare For All can be done. It just can’t be done in the practical world all at once under our system of government. And it can’t be done in four years, as under the Sanders plan.
Our system is not like China, where you can set out 20 year goals and meet them in 15. At best, our system works for change about 2 years out of 8, and then you are likely to get a 4-8 year retraction of some or most of whatever change you made.
Our system of government can do big changes only if there is a massive change election, and then there are limits. LBJ got a massive change election, and he couldn’t get his favored health care plan passed. He had to settle for Medicare and Medicaid, and some community health clinics. That may seem pretty big now, but those plans were small in scale at that time and only later expanded. The only President who made big changes was FDR. He had desperate citizens and complete control of the Congress, but to get his programs passed he had to play ball with the segregationist Democrats.
What you can do under our system is make a good start on improving the the current health care system. A public option or buy-in to Medicare might be doable. Start with those small steps, maybe pilot some things in the states and see where health care can be improved and cost savings can be made.
I don’t believe medicare for all will pass in my life time, but its a start for negotiation with the congressional repubs starting at zero healthcare. Hopefully, they will meet in the middle somewhere with single payer. If Dems start with single payer, it will continue to die just like the people without insurance.
Dang, but Warren is so whip smart! And so good at seeing the whole picture.
I think what she’s laid out is a great aspirational plan that makes clear what her priorities are. If Democrats take all of Capitol Hill, they need to get in gear on this ASAP. Junk the filibuster, screw GOP cries about bipartisanship, which they used to hamstring Obama. Do as much as they can. A public option and her plan to control drug prices are the minimum acceptable starting place.
I think a good way to promote her economic outlook might be “Stop the GOP transfer of wealth away from the middle class.” Or something similar.
GOP likes to cry about “transfer of wealth.” Use that to describe how their enormous tax breaks, unfettered interest rates, soaring drug costs, etc., are “transfers of wealth” to the GOP and their rich owners from the rest of us.
Wow what an original idea. NOT.
I recall a certain other candidate beating this drum longer and louder.
Transfer of wealth to the wealthy is what killing the ACA Obamacare is all about to the tune of hundreds of billions of dollars to the wealthy. South Dakota politicos will be paid handsomely for this robbery. I wonder how much Jackley will pocket.
“The lawsuit by 18 state attorneys general seeking to invalidate the Affordable Care Act would provide an enormous tax cut for wealthy households if it succeeds, according to an analysis by the Center on Budget and Policy Priorities published Monday.
Backed by the Trump administration, the suit claims that the ACA became unconstitutional when the Tax Cuts and Jobs Act effectively eliminated the mandate that required all Americans to purchase health insurance, starting this year. If the ACA is overturned, more than 20 million people could lose their health insurance and costs would likely increase significantly for millions more.” https://finance.yahoo.com/news/wealthy-could-see-huge-tax-232118213.html
Listen to Warren and vote for her, she’s got the ideas to pick this country up again as we have fallen on our arse’s.
Well, I think that medicare for all can happen with Warren. That is if she is VP and Sanders is the P!
I still think that the two of them on the ticket is the only way the Dem’s are going to win the white house.
Medicare was JFK’s idea and, since he didn’t get a chance to put it through, LBJ had to. When the two of them get in they will have to push it just as passionately as JFK was capable of.
I’ve personally known three people that have died because they waited too long to seek healthcare because they didn’t think they could afford it.
Ellee, let’s focus on the fact that it’s a great idea. Let’s all rally around it.
Pie in the sky, Donald? I don’t agree it’s impossible. I do agree that it’s a hard sell.
I love candidates who are willing to try to make the hard sell. If we start the discussion offering 50%, then even if we get honest compromise after we win, 25% may be the best we’ll get (and that assumes we don’t face a completely obstructionist GOP that clings to enough votes in the Senate to sustain a filibuster). Warren is offering 100% and making a serious case for it. Let’s make that case now. Let’s educate with it, build support with it, rally voters behind the values of it, and then see how close we can get to passing it after changing the conversation.
Hey, just checking: can anyone distinguish “Medicare for All” from ‘single payer”?
The two plans are close, but…..
IMO, I think Sanders would be less easily swayed and more of a fighter for med for all.
Medicare for all and single payer are the same thing, however, most people do not know that and will totally fight against Medicare for all. Kind of like being against raising taxes, but user fees are totally acceptable to most people.
cibvet, I think it’s the other way around. “Single payer” is SOCIALISM! Eeeek! But Medicare is known and loved and safe and acceptable.
It’s like how GOP voters hated Obamacare but loved the ACA. 🙄🙄
While this isn’t about Sen. Warren, it is about the Democratic candidates and it’s good news, IMO.
“The Minnesota senator clinched the spot Wednesday with a 5% showing in a Quinnipiac University poll of Iowa. That’s Klobuchar’s best showing to date in the Hawkeye State, whose first-in-the-nation caucus is pivotal to her presidential hopes next year.”
That puts Sen. Klobuchar in the December Democratic debate!
Canada & European nations have both government funded healthcare and private insurance options. There is no reason for exclusivity. The systems can be complimentary. Complimentary systems makes tremendous sense when one fosters systemic transitional change that will occur with the US expanding Medicare for all.
John, I think what is being proposed is the same thing. You would still have your “medicare supplement” to cover what ever med for all doesn’t. Just like we do now. The reason for proposing what they are is that if you have private insurance competing with what the government would be offering they would cherry pick the healthiest and the government would end up with the least healthy and most expensive to the point that it couldn’t work.
Clyde and Debbo make a good point about wording. I hope Warren’s wording can keep the conversation focused on the values at stake, the values that we already embrace and enact in Medicare for senior citizens and which we ought to embrace and enact in our approach to paying for the health care of all Americans.
John reminds us of what Warren and all Democratic candidates should remind us. Medicare for All doesn’t outlaw private insurance. As we discussed in July, Medicare for All will require expanding the private Medicare Advantage. Warren’s plan offers opportunity for everyone.
The point is a candidate advocating for Medicare For All as the only solution is going to lose the election. Too many folks that are needed to vote for the Democratic candidate in swing states will vote against losing their health care over a campaign promise that looks impossible. They want fixes to the current system first, and improvements over time.
Don said, “They want fixes to the current system first, and improvements over time.”
Wondering how you know that?
Donald Pay, don’t be a pessimist!
If we can just get our propaganda machine to tell the truth there is no reason the public won’t go along with it. Do you hear anyone bitching about medicare that is on it now? I believe it works quite well and if there was a major problem with it in the future you can bet it wouldn’t take long to overhaul it or eliminate it.
The problem will be the propaganda machine! They will keep the public from climbing up on the pulpit along with Sanders and Warren.