Senator Elizabeth Warren on Friday released her proposal to pay for Medicare for All, a plan to move every American to government-run health insurance that would reshape the US health care system.
Warren’s plan, outlined in a 9,275-word Medium post, included complex ideas for paying for health care costs after private insurance is ended. It’s a lot to digest, so here are five takeaways.
Much of it is based on the Medicare for All Act
The plan released by Warren on Friday is primarily aimed at answering the question of how to pay for single-payer health care. When it comes to the nuts and bolts of how her health care plan would work, Warren points to the existing Medicare for All Act, that “damn bill” Senator Bernie Sanders colorfully reminded debate viewers that he wrote.
Under the Medicare for All Act, introduced by Sanders in April and cosponsored by Warren, all US residents would be automatically enrolled in a national health care plan administered by the federal government. In addition to traditional medical coverage, the Medicare for All Act includes vision and dental, plus long-term care services.
It relies on a lot of assumptions
At the outset, Warren acknowledges that it’s difficult to predict what health care costs will be in the future, and she notes that current projections about how much Medicare for All would cost vary widely. Because the Medicare for All Act leaves open questions about how the single-payer system would work, including major ones like the amount that health care providers would be compensated, Warren fills in the gaps to arrive at a total cost estimate. Outside analysts, including two local experts, cited by Warren estimate her plan would result in overall US health care costs that are slightly lower than what the nation currently spends.
Arriving at a specific cost allows Warren to figure out how she will pay for it, and there are some assumptions here, too.
To fund the plan without increasing taxes on the middle class, Warren relies on enacting seemingly unrelated legislation, including immigration reform. The pathway to citizenship for millions of people in her immigration proposal would add to the tax base. Warren also wants to cut defense spending.
There aren’t new middle class taxes, but there are hikes for businesses and the wealthy
Warren announced her Medicare for All plan with a major promise not to increase taxes on the middle class, but that doesn’t mean some taxes won’t go up. After accounting for existing federal spending and health care spending by employers that would be redirected to the government, there’s still a big hole. Warren fills it by levying new taxes and closing loopholes in ways that target financial firms and large corporations. She also increases her previously proposed wealth tax.
Some businesses would be hit harder than others. As Vox points out, if Warren asks businesses to send their existing employee health insurance payments to the government, businesses that currently provide inadequate insurance, or no insurance at all, fare much better than those that provide good insurance coverage. That sets up a kind of penalty for businesses that offer health coverage: They’re helping pick up the tab for Medicare for All, but they no longer have an advantage in attracting top talent with generous benefits.
Under Warren’s plan, that situation is temporary as businesses would eventually pay into the system at the same rate. And Warren says employers ultimately will be better off because they won’t get hit with unpredictable changes in health care costs.
It would be difficult to implement
Moving every single American to a new health care plan is a massive endeavor, so much so that Warren says she’ll release an entirely separate plan that deals with how to handle the transition.
The transition has become a sticking point in the Democratic primary, with moderates like former vice president Joe Biden using the lengthy time period (Sanders’ plan says it would take four years) as a reason to oppose it altogether.
And then there’s the problem of passing such legislation: During the debate around the Affordable Care Act in 2010, a proposed public option to allow people to buy into a government-run health care plan nearly sunk the entire bill, and was stripped out of the landmark legislation. The episode underscored the difficulty of implementing a government-run health care program, even one popular with voters.
Warren has a plan for that, though. She wants to get rid of the filibuster, meaning the Senate would need a simple majority to pass legislation, rather than the 60 votes currently required to stop debate.
Warren has been reluctant to go on the offensive, but that may be changing
As she rose in the polls, Warren resisted leveling direct attacks against her primary opponents. Warren’s style has been to rail against the concept of big money fueling a campaign, rather than directly criticizing individual candidates who have taken cash from high-dollar fund-raisers.
But there are hints that this could be changing. Warren’s lengthy Medicare for All plan includes rebuttals to the criticism she’s gotten from the moderate wing of the primary field, calling on candidates who oppose her plan to explain how they would cover everyone.
“Make no mistake — any candidate who opposes my long-term goal of Medicare for All and refuses to answer these questions directly should concede that they have no real strategy for helping the American people address the crushing costs of health care in this country. We need plans, not slogans,” she wrote.