“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.