Over the last few months, debate moderators have demonstrated their willingness to dumb down our politics and parrot Republican talking points by continually asking Elizabeth Warren if her support of Medicare for All would mean that taxes go up for people in the middle class. Her response has been to talk about the cost of health care, regardless of whether it is paid in premiums, deductibles, and co-pays or taxes. That hasn’t satisfied the moderators, who seem to think that it is important to differentiate who Americans pay for their health care rather than how much they pay.
The relentless pursuit of that question in the debates does, however, seem to be hurting Warren. Perhaps that is because she has been backing the Medicare for All plan put forward by Bernie Sanders, who has been clear on this question.
“At the end of the day, the overwhelming majority of people will save money on their health-care bills,” Sanders said at last week’s debate in Ohio. “But I do think it is appropriate to acknowledge that taxes will go up. They’re going to go up significantly for the wealthy. And for virtually everybody, the tax increase they pay will be substantially less than what they were paying for premiums and out-of-pocket expansions.”
Warren’s unwillingness to be that direct is beginning to tarnish her reputation as the plain-talker who tells the truth. That is probably why, on Sunday, she announced that her campaign will release a plan to pay for Medicare for All in the next few weeks. This is where the rubber meets the road and it is possible to begin asking some questions that are actually relevant, as opposed to the ones we’ve seen from debate moderators up to this point.
In order to determine if Warren can keep her promise that costs will go down for people in the middle class, she will need to address two questions that the Sanders proposal doesn’t.
How much will providers be paid?
In order to determine the overall cost of Medicare for All, Warren’s plan will need to begin by answering the question of how much providers will be paid. Under our current system, private insurers pay providers significantly more than Medicare. The most substantial form of cost control can be found in bringing those payments closer to Medicare rates. While Warren has consistently made insurers the villains of our health care system, she has not demonstrated a willingness to take on providers.
Contrary to what many people believe, the issue of how much to pay providers was a major contributor to the downfall of the public option during the debate over Obamacare, demonstrating that it can be politically toxic. But any plan to move forward with either a public option or single payer must address this issue in order to be viable.
How will it be paid for?
Bernie Sanders has released a set of options about how to pay for Medicare for All, but hasn’t put forward a specific plan. That makes it impossible to assess the effect on individual Americans. In order to determine whether Warren’s plan meets the goal of bringing down costs for middle class families, she will need to identify which taxes will be tapped to pay for the plan.
It is worth noting that, when Sanders talks about the tax increases that will be needed to pay for Medicare for All, he says that, other than the wealthy, “virtually everybody” else will pay substantially less for health care than they do now. Jonathan Cohn provides an example of someone who might fall outside that qualifier.
Imagine, for example, a 30-year-old who today buys a minimalist policy directly from an insurer ― say, one of the “bronze” plans with relatively skimpy benefits that barely meet the Affordable Care Act’s coverage standards. Because that plan covers so little and because 30-year-olds pay lower premiums than older people, that bronze plan is probably pretty cheap.
The bronze plan could easily cost less than the new taxes for Medicare for All and maybe a lot less, depending on how much money the 30-year-old makes and just how skimpy that plan is.
But perhaps even more significant are those middle class Americans whose employer pays for all or most of their health insurance premium. It is very likely that under Medicare for All, they would be taxed at a rate higher than they’re currently paying.
These are issues that advocates for single payer, including Bernie Sanders, have avoided addressing. It is true that Medicare for All would be a more efficient way to deliver health care and that overall, it would likely cost less than the current system. But major issues emerge when we begin to address the challenge of transitioning from the status quo to single payer.
Warren has been clear that she will only support a plan that reduces costs for middle class families (I would assume that also applies to middle class individuals). So the target has been established. When she releases her plan, we’ll analyze it in order to determine if she can address these two major questions and reach that goal.